061 - Transjugular Intrahepatic Portosystemic Shunting in the Management of Hepatic Hydrothorax
Nicholas Kemper, Medical Student – Medical Student, University of Louisville School of Medicine; Samuel Bockhorst, MD – Resident, Radiology, University of Louisville School of Medicine; Kyle Rizenbergs, MD – Resident, Radiology, University of Louisville School of Medicine; Bryan Glaenzer, MD – Attending Physician, Radiology, University of Louisville School of Medicine
Purpose: Hepatic hydrothorax (HH) is a rare sequela of cirrhosis, severe ascites, and portal hypertension, presenting sth pleuritic symptoms, dyspnea, and a transudative pleural effusion. Diagnosis requires exclusion of other causes of pleural effusion, including infection, CHF, pulmonary malignancy, and primary lung disease. Nuclear medicine shunt studies are used to prove the pathophysiology of HH. Hepatic hydrothorax has a poor prognosis, as 25% of cases are refractory to standard treatment. Medical management involves diuresis, salt restriction, and therapeutic thoracentesis. TIPS is a minimally invasive technique to reduce portal pressures and treat portal hypertension, variceal bleeding, refractory ascites, and hepatic hydrothorax. This retrospective chart review sought to evaluate the efficacy of TIPS to treat HH.
Material and Methods: An institutional review board-approved chart review at our institution from July 2017 to June 2022, and carts were searched for operative notes, nuclear medicine shunt studies, HH recurrence, complications, and survival. Patients whose TIPS were not initially effective were not used to calculate time to HH recurrence.
Results: Retrospective chart review identified 68 patients with hepatic cirrhosis and pleural effusion that did not meet exclusion criteria. TIPS placement following HH diagnosis was performed in 14 patients. Of these, HH was diagnosed via nuclear medicine shunt study for 10 patients. For 11 of the 14 patients, the average number of months without HH recurrence after TIPS was 16 months. The longest period without HH recurrence was 39 months. Two patients had one or more TIPS revisions. One patient who had three TIPS revisions has had 22.75 months without HH recurrence after the most recent revision. This case series includes two mortalities, one of which was the direct result of recurrent HH. Two cases had no resolution of hepatic hydrothorax or abdominal ascites after TIPS and were not included in the calculation of the average time of HH absence after TIPS.
Conclusions: This case series provides support that TIPS and TIPS revisions are efficacious treatments for HH and that TIPS revisions may be necessary to provide patients with morbidity and mortality benefits. Future studies are needed to study the effect of shunt study performance on TIPS outcomes, and comparative studies for long-term outcomes in multiple TIPS revisions.