2016 Volume 49 Issue 7 Pages 511-516
The patient was a 50-year-old female who had been receiving dialysis for 21 months. She had hepatitis C virus-related liver cirrhosis (Child-Pugh B-C) and was on maintenance dialysis for hepatic glomerulosclerosis-associated end-stage renal disease. Respiratory failure occurred due to massive right-sided pleural effusion and left-sided pneumonia, and she was admitted to our department. Oxygen and antimicrobial agents were administered, a right chest drain was installed, and the pleural effusion was drained. The left-sided pneumonia improved, and the amount of the pleural effusion passing through the drain decreased on the 14th hospital day. The chest drain was removed on the 20th hospital day, but the massive right-sided pleural effusion reappeared after 3 days and so the chest drain was re-inserted. Leaking pleural effusion was noted during pleural effusion testing, a bacterial culture was negative, cytology was negative, and no left cardiac dysfunction or abnormal wall movement was detected during echocardiography. Based on these findings and the patient’s clinical course, she was diagnosed with hepatic hydrothorax. The patient’s pleural effusion remained intractable and so pleurodesis was selected. The pleurodesis succeeded after it was applied twice using 4 g of talc and once using OK432 5KE, and no further accumulation of pleural effusion around the right lung was seen. Hepatic hydrothorax is often treatment-resistant in dialysis patients, and pleurodesis might be a useful option in such cases.
