SESSION TITLE: Pleural Disease Posters
SESSION TYPE: Original Investigation Poster
PRESENTED ON: Wednesday, October 29, 2014 at 01:30 PM - 02:30 PM
PURPOSE: The diseased liver leads to deleterious effects on multiple organ systems including the pleura .Pleural complication of liver diseases including hepatic hydrothorax, empyema, chylothorax, pneumothorax and hydropneumothorax. Objective:To determine clinical characteristics, causes and outcomes of pleural complications in cirrhotic patients.
METHODS: One hundried cirrhotic patients were studied. All patients underwent chest x ray, abd. & chest sonography or CT to detect the existence of pl. complications. Pleural fluid was obtained after thoracentesis and sent for analysis [Biochemical,Haematological, Microbiological(culture and stain) andcytological]. The clinical and laboratory data from All patients were studied.
RESULTS: Pl. effusion is the common findings in cirrhotic patients followed by Pyopneumothorax then Pneumothorax. Most common cause of pleural effusion was sterile hepatic hydrothorax; (HH) followed by SBE, &empyema. The mean age of the patient was50.47±10.38. The incidence of SBE was15% (15 of 100) in cirrhotic patients and 18.8% (15 of 80) in cirrhotics with hydrothorax. Fifteen patients had SBE, 66.7% (10 of 15) of these SBE was associated with SBP. The microorganisms identified in PF were E.coli in 4, Strept. in 6, S.aureus in 10, K.pneumoniae in 3, and 1 with Pseudomonas. The pleural fluid of cirrhotic patientsshowed significantly lower levels of total protein, Patients with SBE had a higher Child-Pugh score, lower serum albumin, prolonged proth. time, lower PF protein, and higher rate of associated SBP than patients with sterile hydrothorax. There was no statistically significant relation between amount of ascites, Child-Pugh classification and amount of eff. Shortness of breath (90%), cough (46%), fever (56%), chest pain (25%), abdominal pain (48),abdominal tenderness(40%) and altered mental status (25%) are the most commonsymptoms. The mortality rate was 28%. Improvement was achieved in 72% of patients with pleural complications byantibiotics, diuretics, antituberculous drugs and chest tube insertion.
CONCLUSIONS: The most common cause of pl. effusion in hepatic Patients was H.hydrothorax followed by SBE .Patients with, a higher Child-Pugh score,low PF protein, or SBP are predisposed to SBE. Thoracentesis should be performed in cirrhotic patients with pl. eff. when infection is suspected or clinical deterioration occurs.SBE& empyema is associated with high mortality.
CLINICAL IMPLICATIONS: Early detection of pleural complications in cirrotic patients can improve prognosis and outcomes.
DISCLOSURE: The following authors have nothing to disclose: Hamdy Mahmoud, ISmail Mobarak, Usma Arafa
No Product/Research Disclosure Information