2007 Volume 48 Issue 2 Pages 65-70
A 45-year-old man with decompensated alcoholic liver cirrhosis was admitted to our hospital because of dyspnea. Chest-X-ray film and computed tomography demonstrated a moderate ascites and a massive effusion in right hemithorax which caused respiratory failure, and a chest tube was necessary. Pleural fluid study showed polymorphonuclear cell concentration greater than 500 cells/μL, indicating spontaneous bacterial empyema (SBEM). Treatment with antibiotics improved infection, but pleural fluid from the chest tube did not reduce and it could not be removed. Loss of protein from the chest tube exacerbated hypoalbuminemia which seemed to be one of the causes of intractable hydrothorax. To improve hepatic hydrothorax, chemical pleurodesis with OK-432 was performed twice, resulting in a successful reduction of pleural fluid and the chest tube could be removed. This case demonstrates the usefulness and tolerance of chemical pleurodesis for intractable hepatic hydrothorax after SBEM in which the chest tube is difficult to be removed because of continuous outflow.
