Chemical Pleurodesis in the Management of Hepatic Hydrothorax

Background: Chemical pleurodesis is an effective treatment for malignant effusion and pneumothorax. Although this mode of therapy is less widely accepted in treatment of patients with hepatic hydrothorax, the need of palliative treatment in such patients encouraged us to do this work. Study Objectives: To analyze the outcome of chemical pleurodesis using Iodopovidone, vibramycin and talc slurry in treatment of hepatic hydrothorax. Patients and Methods: Randomized study on 20 patients with symptomatic right side hepatic hydrothorax not responding to medical treatment and repeated thoracocenthesis. All underwent medical thosacoscopies to achieve pleurodesis by application of 3 sclerosing agents. Results: patients were 16 men and 4 women with a mean age 54.3±8.1 years (range 42-70 years). The procedure was effective in 15 of 20 patients (75%), 7/8 cases treated by lodopovidone (87.5%), 4/6 cases with vibramycin and talc slurry (66.7%) for each. There were 4 recurrences (20%) and a single case of mortality (5%) due to hepatic coma which can be attributed to the course of the disease. We detected minimal morbidity during the follow up period of 3 months. Conclusion: The procedure appears to be effective in patients with refractory hydrothorax. Chemical pleurodesis deserves to be considered as an alterative therapy in such patients.