Two Cases of Refractory Hepatic Hydrothorax Treated Successfully with Transjugular Intrahepatic Portosystemic Shunt

Tsutomu Fujii, Soichiro Inoue, Hiroyuki Sugimoto, Shin Takeda and Akimasa Nakao

Department of Surgery II, Graduate School and Faculty of Medicine, Nagoya University

We report herein two cases of refractory hepatic hydrothorax treated successfully with a transjugular intrahepatic portosystemic shunt (TIPS). Case 1: A 62-year-old man with Child'Pugh class C liver cirrhosis associated with hepatitis C virus had been treated repeatedly with radiofrequency ablation therapy or TAE for HCC. He was admitted to our hospital because of dyspnea in August 2003. A massive right-sided pleural effusion was drained, yielding over 6,000 ml of fluid per day. The cytology of the effusion was negative for cancer. He was treated with diuretics, albumin, sodium restriction, and pleurodesis using OK-432, all of which failed to relieve his symptoms. On hospital day 39, TIPS was placed. After creation of the shunt communicating the right hepatic vein to the portal vein, the pleural effusion was successfully decreased, resulting in complete relief of his symptoms. He was able to be discharged on postoperative day 11. Case 2: A 61-year-old man with Child's-Pugh class B liver cirrhosis associated with hepatitis C virus was also treated repeatedly for HCC. He was admitted for uncontrollable right pleural effusion in August 2004. All conservative therapy failed, so TIPS procedure was performed. He was discharged on postoperative day 6, but was re-admitted on an emergence basis due to hepatic encephalopathy 1 week later. His consciousness improved after the treatment, and he has been free of symptoms for 1 year after the procedure.

Key words
transjugular intrahepatic portosystemic shunt, hepatic hydrothorax, HCC

Reprint requests
Tsutomu Fujii Department of Surgery II, Graduate School and Faculty of Medicine, Nagoya University
65 Tsuruma-cho, Showa-ku, Nagoya, 466-8550 JAPAN

Accepted
November 30, 2005

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