Hepatic hydrothorax resistant to diuretics treated with octreotide

Introduction and Objective

Hepatic hydrothorax is the excessive accumulation of transudate in the pleural cavity, secondary to portal hypertension in cirrhotic patients without existing cardiopulmonary disease. Treatment includes a reduction in ascites production, prevention of ascites transfer to the pleural space, pleural fluid removal, pleural space obliteration, and liver transplantation. This study aimed to report a case of hepatic hydrothorax treated with Octreotide.

Case Summary

A 63-year-old man with liver cirrhosis due to alcohol. It began with edema in the pelvic limbs, increased abdominal perimeter, MRC II dyspnea, orthopnea, and chest pain radiating to the back. EF: scleral jaundice, 60% left pleural effusion. Gii ascites, MPI edema (+). He was classified as Child-Pugh C (12 points), Hb 6.2, Leu 2.2, Plts 37,000, INR 2.1, chest X-ray: 100% left pleural effusion. A 1200 cc cytological/cytochemical thoracentesis was performed: transudate according to Light's criteria, GASA >1.1, BNP 87 mg/dl; spironolactone was started up to 200/80 mg, persists with 100% pleural effusion. Octreotide 100mcg is started for five days. He showed improvement at the end of treatment.

Discussion

In hepatic hydrothorax, sodium restriction as a treatment is insufficient; the use of diuretics is necessary; up to 30-40% do not respond; the placement of chest tubes is associated with high morbidity, clinical deterioration, TIPS, urgent HT or death. Octreotide, a somatostatin analog, directly inhibits RAAS, improving the efficiency of renal plasma flow and natriuresis.

Conclusions

Octreotide can be a useful alternative in hepatic hydrothorax.

Funding

The resources used in this study were from the hospital without any additional financing

Declaration of interest

The authors declare no potential conflicts of interest.