Transjugular intrahepatic portosystemic shunt for recurrent hepatic hydrothorax

For many years, pleural effusions have been recognized as a complication of cirrhosis, occurring in approximately 5.5% of patients. Recent studies hav e confirmed that small defects in the diaphragm allow for passage of asciti c fluid into the pleural space. Successful management of these patients is challenging, as many of the treatment options can be associated with increa sed morbidity. The initial treatment should focus on eliminating and preven ting the recurrence of ascites with diuretics and water and salt restrictio n. For those patients who do not respond medically, more invasive technique s have been used including serial thoracentesis, chest tube placement, chem ical pleurodesis, and peritoneovenous shunts. We present a patient with rec urrent pleural effusions secondary to hepatic cirrhosis who was unsuccessfu lly treated medically, and subsequently treated with thoracentesis, chest t ube drainage and pleurodesis, with ultimate resolution after transjugular i ntrahepatic portosystemic shunt placement. (C) 2000 by The Society of Thora cic Surgeons.