TREATMENT-REFRACTORY HYDROTHORAX IN PRIMA RY BILIARY-CIRRHOSIS - SUCCESSFUL TREATMENT WITH A TRANSJUGULAR INTRAHEPATIC PORTOSYSTEMIC STENT-SHUNT

History and clinical findings: A 55-year-old woman with known primary biliary cirrhosis (PBC) was hospitalized because of increasing dyspnoe a. A year before she had for the first time experienced a right-sided pleural effusion which had to be drained every 4 weeks. Physical exami nation revealed dullness on percussion and greatly decreased breath so unds on auscultation over the entire right thorax. In addition there w ere signs of moderate ascites and leg oedema. Investigations: Chest ra diograph showed a homogeneous shadowing of the right thorax without me diastinal shift. Diagnostic thoracocentesis produced a serous effusion , a transudate on chemical analysis, comparable to the composition of the ascitic fluid. Bacteriological and cytological tests on both fluid s were unremarkable. Treatment and course: The right pleural effusion was presumed to be due to a hydrothorax from the ascites caused by por tal hypertension associated with the PBC. Despite continous diuretic t reatment and thoracocenteses with albumin substitution every 3 days th ere was no improvement and implantation of a transjugular intrahepatic portosystemic stent shunt (TIPSS) was performed. This effectively low ered portal pressure and markedly improved the patient's condition so that further thoracocenteses were no longer necessary. 3 weeks after T IPSS implantation she was discharged in good condition. Radiography 3 weeks later demonstrated continued reduction in the hydrothorax. Concl usion: Hydrothorax is a rare complication of liver cirrhosis. TIPSS im plantation can provide lasting resolution and corresponding clinical i mprovement of a hydrothorax, especially in those conditions which are refractory to diuretic treatment and thoracocentesis.