UI  - 98027736
TI  - Refractory hydrothorax in primary biliary cirrhosis: successful
      treatment with transjugular intrahepatic portosystemic stent shunt.
AB  - HISTORY AND CLINICAL FINDINGS: A 55-year-old woman with known primary
      biliary cirrhosis (PBC) was hospitalized because of increasing
      dyspnoea. A year before she had for the first time experienced a
      right-sided pleural effusion which had to be drained every 4 weeks.
      Physical examination revealed dullness on percussion and greatly
      decreased breath sounds on auscultation over the entire right thorax.
      In addition there were signs of moderate ascites and leg oedema.
      INVESTIGATIONS: Chest radiograph showed a homogeneous shadowing of
      the right thorax without mediastinal shift. Diagnostic
      thoracocentesis produced a serous effusion, a transudate on chemical
      analysis, comparable to the composition of the ascitic fluid.
      Bacteriological and cytological tests on both fluids were
      unremarkable. TREATMENT AND COURSE: The right pleural effusion was
      presumed to be due to a hydrothorax from the ascites caused by portal
      hypertension associated with the PBC. Despite continuous diuretic
      treatment and thoracocentesis with albumin substitution every 3 days
      there was no improvement and implantation of a transjugular
      intrahepatic portosystemic stent shunt (TIPSS) was performed. This
      effectively lowered portal pressure and markedly improved the
      patient's condition so that further thoracocentesis were no longer
      necessary. 3 weeks after TIPSS implantation she was discharged in
      good condition. Radiography 3 weeks later demonstrated continued
      reduction in the hydrothorax. CONCLUSION: Hydrothorax is a rare
      complication of liver cirrhosis. TIPSS implantation can provide
      lasting resolution and corresponding clinical improvement of a
      hydrothorax, especially in those conditions which are refractory to
      diuretic treatment and thoracocentesis.