Open Journal of Gastroenterology, 2013, 3, 196-201 OJGas http://dx.doi.org/10.4236/ojgas.2013.33031 Published Online July 2013 (http://www.scirp.org/journal/ojgas/ ) Towards an easier pleurodesis: Ultrasound-guided iodopovidone sclerotherapy in cirrhotic patients with hepatic hydrothorax * Ahmed M. Abdelhafeez 1 , Mohammed W. Zakaria 1 , Waleed F. Fathalah 2# , Dalia Omran 2 1 Chest Department, Faculty of Medicine, Cairo University, Cairo, Egypt 2 Endemic Medicine and Hepatology Department, Faculty of Medicine, Cairo University, Cairo, Egypt Email: # walfou2000@gmail.com Received 29 April 2013; revised 30 May 2013; accepted 10 June 2013 Copyright © 2013 Ahmed M. Abdelhafeez et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background and Aim: Hepatic hydrothorax is one of the complications encountered in end stage liver dis- ease. Pleural drainage carries the risk of massive pro- tein and electrolyte depletion as well as the risk of bleeding and hepatic encephalopathy. Pleurodesis fol- lowing pleural aspiration decreases the chance of pleural effusion recurrence, and has been a widely used long-standing method of controlling recurrent pleural effusions. The aim of this study is to evaluate the effect of pleurodesis using ultrasound-guided io- dopovidone sclerotherapy in hepatic hydrothorax. Patients and Methods: This prospective study in- cluded 56 patients with clinical, laboratory and ra- diological evidence of liver cirrhosis and symptomatic right sided hepatic hydrothorax. All patients were sub- jected to repeated thoracentesis. Ten ml of lidocaine 2% were injected in the pleural space followed by 20 ml of iodopovidone. The follow-up was done after 3 months. Results: The sclerotherapy procedure was suc- cessful in 40 out of 56 cases (71.4%), and the success rate was 66.7% in massive effusion and reached 80% in moderate effusion. Twenty eight patients (50%) had to repeat the procedure for a second time, sixteen of which (28.6%) failed despite the second trial and twelve cases (21.4%) showed no fluid reaccumulation. Conclusion: Ultrasound-guided iodopovidone sclero- therapy is an effective approach for a successful pleu- rodesis in hepatic hydrothorax. Keywords: Pleurodesis; Ultrasound; Iodopovidone; Effusion 1. INTRODUCTION Hepatic hydrothorax is a complication of end stage liver disease [1], ranging from 4% to 6%, and up to 10% with advanced disease [2]. It refers to the abnormal accumula- tion of more than 500 milliliters of transudative pleural effusion in patients with liver cirrhosis where a cardiac and pulmonary cause of pleural effusion has been ruled out [1]. Mostly this is a right sided effusion, which could be bilateral, and rarely it is isolated left sided effusion. Oc- casionally, a hepatic hydrothorax may be present in the absence of ascites [3]. Causes of hepatic hydrothorax include leakage from the thoracic duct, leakage through lymphatic channels in the diaphragm and leakage through diaphragmatic de- fects [4]. The effusion is usually a transudate, however, due to a higher absorptive pleural capacity, the protein content of the pleural effusion is usually slightly higher than that of the ascitic fluid. Transmission of spontaneous bacterial peritonitis to the pleural cavity further changes the crite- ria of fluid analysis [5]. A chylothorax of cirrhotic origin can rarely be diagnosed by the usual criteria [6]. It was also found that spontaneous empyema can present in 15% of patients [7]. Traditional treatment of hepatic hydrothorax in a pa- tient who failed medical management of ascites remains problematic and controversial and no guideline for an ideal method is available at the present [8]. Pleurodesis following pleural aspiration decreases the chance of pleural effusion recurrence, and has been a widely used long-standing method of controlling recur- rent pleural effusions [9]. * Disclosure: Nothing to disclose. No financial support. Financial conflict: No conflict. # Corresponding author. OPEN ACCESS