Amir Khalil, Suma Alzouhayli, Silvia Novakova, Saad Shams, Ahmad Baiyasi, M. Khalil, M. Uddin, A. Shiari, Kareem Bazzy
{"title":"两次轻拍:一例自发性细菌性脓胸患者迅速再积聚的肝性胸水","authors":"Amir Khalil, Suma Alzouhayli, Silvia Novakova, Saad Shams, Ahmad Baiyasi, M. Khalil, M. Uddin, A. Shiari, Kareem Bazzy","doi":"10.55504/2473-2869.1253","DOIUrl":null,"url":null,"abstract":"Hepatic hydrothorax (HH) is a complication of decompensated liver cirrhosis that only occurs in about 5–6% of cirrhosis patients, defined as a pleural fluid in the setting of known liver disease, with the absence of any other cardiopulmonary etiology. Infected HH is a rare complication, designated as spontaneous bacterial empyema (SBEM), found in only 13–16% of patients with HH. This case follows a patient with SBEM who developed a recurrent pleural effusion minutes after thoracentesis. Our patient is a 56-year-old female with a history of alcoholic cirrhosis with pleuritic pain found to have right-sided pleural effusion with decompensation. She had no ascites. She was initiated on antibiotics due to leukocytosis and underwent thoracentesis, revealing a sterile but exudative pleural effusion with high neutrophil count, confirming the diagnosis of SBEM. Despite initial symptom relief, her respiratory symptoms recurred within mere minutes of thoracentesis. Imaging showed reaccumulated right-sided effusion, and repeat thoracentesis showed a transuda-tive effusion, suggesting HH. While she was in our care, we pursued expert consultation with gastroenterology and thoracic surgery; based on our shared clinical decision making, we agreed that definitive intervention with either indwelling catheter or intrapleural surgical options would cause more harm than good to our patient given her decompensated alcoholic cirrhosis. The patient was discharged with instructions for serial thoracentesis and close follow-up with gas-troenterology to discuss next steps regarding her advanced and uncontrolled cirrhosis. We refer to this case to discuss HH and its rare complication of SBEM, as well as the management options for patients with these conditions.","PeriodicalId":91979,"journal":{"name":"The University of Louisville journal of respiratory infections","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2023-05-24","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Tapped Twice: A Case of a Rapidly Re-accumulating Hepatic Hydrothorax in a Patient with Spontaneous Bacterial Empyema\",\"authors\":\"Amir Khalil, Suma Alzouhayli, Silvia Novakova, Saad Shams, Ahmad Baiyasi, M. Khalil, M. Uddin, A. Shiari, Kareem Bazzy\",\"doi\":\"10.55504/2473-2869.1253\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"Hepatic hydrothorax (HH) is a complication of decompensated liver cirrhosis that only occurs in about 5–6% of cirrhosis patients, defined as a pleural fluid in the setting of known liver disease, with the absence of any other cardiopulmonary etiology. Infected HH is a rare complication, designated as spontaneous bacterial empyema (SBEM), found in only 13–16% of patients with HH. This case follows a patient with SBEM who developed a recurrent pleural effusion minutes after thoracentesis. Our patient is a 56-year-old female with a history of alcoholic cirrhosis with pleuritic pain found to have right-sided pleural effusion with decompensation. She had no ascites. She was initiated on antibiotics due to leukocytosis and underwent thoracentesis, revealing a sterile but exudative pleural effusion with high neutrophil count, confirming the diagnosis of SBEM. Despite initial symptom relief, her respiratory symptoms recurred within mere minutes of thoracentesis. Imaging showed reaccumulated right-sided effusion, and repeat thoracentesis showed a transuda-tive effusion, suggesting HH. While she was in our care, we pursued expert consultation with gastroenterology and thoracic surgery; based on our shared clinical decision making, we agreed that definitive intervention with either indwelling catheter or intrapleural surgical options would cause more harm than good to our patient given her decompensated alcoholic cirrhosis. The patient was discharged with instructions for serial thoracentesis and close follow-up with gas-troenterology to discuss next steps regarding her advanced and uncontrolled cirrhosis. We refer to this case to discuss HH and its rare complication of SBEM, as well as the management options for patients with these conditions.\",\"PeriodicalId\":91979,\"journal\":{\"name\":\"The University of Louisville journal of respiratory infections\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2023-05-24\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"The University of Louisville journal of respiratory infections\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.55504/2473-2869.1253\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"The University of Louisville journal of respiratory infections","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.55504/2473-2869.1253","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
Tapped Twice: A Case of a Rapidly Re-accumulating Hepatic Hydrothorax in a Patient with Spontaneous Bacterial Empyema
Hepatic hydrothorax (HH) is a complication of decompensated liver cirrhosis that only occurs in about 5–6% of cirrhosis patients, defined as a pleural fluid in the setting of known liver disease, with the absence of any other cardiopulmonary etiology. Infected HH is a rare complication, designated as spontaneous bacterial empyema (SBEM), found in only 13–16% of patients with HH. This case follows a patient with SBEM who developed a recurrent pleural effusion minutes after thoracentesis. Our patient is a 56-year-old female with a history of alcoholic cirrhosis with pleuritic pain found to have right-sided pleural effusion with decompensation. She had no ascites. She was initiated on antibiotics due to leukocytosis and underwent thoracentesis, revealing a sterile but exudative pleural effusion with high neutrophil count, confirming the diagnosis of SBEM. Despite initial symptom relief, her respiratory symptoms recurred within mere minutes of thoracentesis. Imaging showed reaccumulated right-sided effusion, and repeat thoracentesis showed a transuda-tive effusion, suggesting HH. While she was in our care, we pursued expert consultation with gastroenterology and thoracic surgery; based on our shared clinical decision making, we agreed that definitive intervention with either indwelling catheter or intrapleural surgical options would cause more harm than good to our patient given her decompensated alcoholic cirrhosis. The patient was discharged with instructions for serial thoracentesis and close follow-up with gas-troenterology to discuss next steps regarding her advanced and uncontrolled cirrhosis. We refer to this case to discuss HH and its rare complication of SBEM, as well as the management options for patients with these conditions.