A case of intractable hepatic hydrothorax successfully treated by chemical pleurodesis after spontaneous bacterial empyema

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  • 胸膜癒着術が奏効したアルコール性肝硬変に合併した特発性細菌性胸膜炎（ＳＢＥＭ）後難治性胸水の１例
  • 症例報告 胸膜癒着術が奏効したアルコール性肝硬変に合併した特発性細菌性胸膜炎(SBEM)後難治性胸水の1例
  • ショウレイ ホウコク キョウマク ユチャクジュツ ガ ソウコウシタ アルコールセイ カンコウヘン ニ ガッペイシタ トクハツセイ サイキンセイ キョウマクエン SBEM コウ ナンチセイ キョウスイ ノ 1レイ

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Abstract

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.<br>

Journal

  • Kanzo

    Kanzo 48 (2), 65-70, 2007

    The Japan Society of Hepatology

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