Hepatic hydrothorax is a complication of advanced cirrhosis of the liver. It occurs when the liver can no longer filter blood properly and backs up, causing fluid from the abdomen to move into the cavity around the lungs. This backup of fluid can cause shortness of breath and other complications.
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What Is Hepatic Hydrothorax?
Hepatic hydrothorax is a result of advanced liver disease. As cirrhosis of the liver progresses, it will impact the liver’s ability to properly filter blood. Improper filtering of blood leads to blockages that cause the buildup of fluid in the area around the liver. This fluid will then progress into the chest cavity near the lungs, which can greatly impair breathing.
How common is hepatic hydrothorax?
About 4.5 million people in the U.S. have liver disease. Almost 43,000 die each year from chronic liver disease and cirrhosis.
About 5% to 10% of people with cirrhosis end up getting hepatic hydrothorax, making it relatively uncommon.
What causes hepatic hydrothorax?
Hepatic hydrothorax is a result of advanced cirrhosis of the liver or other advanced liver disease impairing the liver to the degree that it cannot process blood properly. Poor blood filtering causes a buildup of fluids that would normally be processed by the liver. Instead, they are expelled into the chest cavity. This fluid can build up in the right side of the body and put pressure on the lungs, causing shortness of breath.
Hepatic hydrothorax risk factors
Conditions that can affect the esophagus, stomach, and liver can all lead to hepatic hydrothorax. This condition can have its own complications, but it can also lead to bacterial infection, which can have high morbidity.
You're at an increased risk for hepatic hydrothorax if you have cirrhosis or other advanced liver diseases, such as:
- Ascites (fluid in the belly).
- Esophageal varices (swollen veins in the esophagus).
- Portal hypertension (high blood pressure around the liver).
- Small, otherwise harmless holes in the diaphragm, present from birth, that allow fluid to enter the lungs.
Complications of hepatic hydrothorax
Left undiagnosed, hepatic hydrothorax can cause hypoxia (lack of oxygen), nausea, and shortness of breath. Hepatic hydrothorax can also lead to bacterial infection caused by the buildup of fluid, which can be fatal if not caught early.
How can I prevent hepatic hydrothorax?
As hepatic hydrothorax is a result of advanced liver diseases, you should already be taking steps to monitor and look after your liver. Changing your diet is a good start, as reducing salt intake can lower your blood pressure in the liver and reduce water retention to alleviate the symptoms of hepatic hydrothorax.
What Are the Signs and Symptoms of Hepatic Hydrothorax?
Hepatic hydrothorax mainly happens on the right side of the body, where the liver is. The right lung becomes compressed when fluid builds up around it.
Signs of hepatic hydrothorax include:
- A dry cough that doesn't produce mucus.
- Chest pain.
- Fatigue.
- Fluid on the right side of the chest.
- Low levels of oxygen in the blood.
- Shortness of breath.
When should I see a doctor about my hepatic hydrothorax symptoms?
If you are experiencing the symptoms of hepatic hydrothorax, you should see your doctor as soon as possible. You may need to see a specialist, like a gastroenterologist.
How Do You Diagnose Hepatic Hydrothorax?
Your doctor will do a physical exam and ask you about your health history.
Fluid in the lung cavity can occur with other conditions, such as heart disease. If someone has liver disease but not heart disease, the fluid in the lung cavity is more likely to be hepatic hydrothorax.
Tests to diagnose hepatichydrothorax
Your doctor may order the following tests to confirm a diagnosis:
- CT scan of the chest.
- Thoracentesis to test fluid in the lung cavity.
- Ultrasound of the liver.
Hepatic hydrothorax prognosis
The prognosis for hepatic hydrothorax is dependent on the progression of the cirrhosis of the liver. If caught early, there is a greater chance of correcting the complications of the condition. However, if the condition is very advanced, it can lead to great discomfort and a heightened rate of morbidity.
How Do You Treat Hepatic Hydrothorax?
Some ways your doctor may treat hepatic hydrothorax include:
Changing your diet
Your doctor will likely ask you to limit your salt (sodium) intake.
Salt causes you to retain water, which can add to fluid build-up in and around the lungs.
Medicine
Your doctor may prescribe diuretics (water pills) to help rid your body of salt and water.
Less body salt and water can help lower high blood pressure in the liver.
Surgery
Your doctor may decide the best approach to treat your hepatic hydrothorax is surgery.
Surgical procedures to treat hepatic hydrothorax include:
- Paracentesis — Removes fluid from the abdominal cavity. Doctors use it to treat ascites. It can also ease pressure on the lungs and provide relief for those with hepatic hydrothorax.
- Thoracentesis — Removes fluid from the space around the lungs. It can provide relief from shortness of breath.
- Transjugular intrahepatic portosystemic shunt (TIPS) — Reduces portal hypertension by bypassing the damaged liver. Doctors connect the portal and hepatic veins, then insert a stent to increase blood flow. The shunt helps ease pressure on the veins and relieve fluid build-up in the abdominal and lung cavities.
If other treatments don't work and you're healthy enough, your doctor might recommend:
- Liver transplant — Removes your damaged liver and replaces it with a healthy liver from a deceased organ donor or a healthy lobe from a living donor.
How effective is treatment?
Treatment effectiveness is mostly dependent on the progression of the liver diseases that caused the hepatic hydrothorax. Catching the signs of liver diseases that can cause this condition early will result in the best chances of preventing severe complications.
