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Recurrent Hydrothorax and Surgical Diaphragmatic Repair: Report of 2 Cases and Review of the Literature

Christine Argento, A. MD*; Kim, Anthony MD; Knauert-Brown, Melissa MD, PhD*; Boffa, Daniel MD; Siegel, Mark D. MD*; Jafari, Behrouz MD, PhD*; Puchalski, Jonathan T. MD, MEd*,‡

Journal of Bronchology & Interventional Pulmonology: April 2014 - Volume 21 - Issue 2 - p 150–153
doi: 10.1097/LBR.0000000000000047
Case Reports

Background: Pleural effusions may result from intra-abdominal processes and sometimes present with dramatic clinical consequences. We present 2 cases of recurrent hydrothorax requiring surgical repair of diaphragmatic defects and describe when surgery may be the best treatment modality.

Patient 1: A 63-year-old man with end-stage renal disease requiring peritoneal dialysis presented with dyspnea on exertion that progressed to cardiac arrest. He was found to have a tension hydrothorax that was initially stabilized with thoracentesis and tube thoracostomy. He eventually underwent surgical repair of fenestrations with complete resolution of his effusion.

Patient 2: A 52-year-old man with recurrent hydrothorax in the context of hepatitis C cirrhosis and hepatocellular carcinoma following radiofrequency ablation to his liver had recurrent admissions with dyspnea and a large pleural effusion. When medical therapy failed, he underwent surgical repair of a large diaphragmatic defect.

Conclusions: Hydrothorax related to peritoneal dialysis or cirrhosis may cause life-threatening scenarios in which medical management may stabilize the patient. Ultimately, surgical corrections of diaphragmatic defects may be necessary for definitive management in selected patients. Although these scenarios are rare, clinicians should be aware of these possibilities as early collaboration between medical and surgical services is essential for optimal patient care.

Divisions of *Pulmonary, Critical Care and Sleep Medicine

Thoracic Surgery

Thoracic Interventional Program, Yale University School of Medicine, New Haven, CT

Disclosure: There is no conflict of interest or other disclosures.

Reprints: A. Christine Argento, MD, Emory University, 550 Peachtree St, NE, 6th Floor, Atlanta, GA 30308 (e-mail: christine.argento@emory.edu).

Received May 21, 2013

Accepted January 20, 2014

© 2014 by Lippincott Williams & Wilkins.