Jorge Vidal Hernandez Rodriguez*, Adrian Rodriguez Garcia and Olga Campesino Ramos
Intensive Care Unit, Hospital el Bierzo, Ponferrada, Leon, Spain
Received: 12 November, 2014; Accepted: 16 December, 2014; Published: 18 December, 2014
Jorge Vidal Hernandez Rodriguez, Intensive Care Unit, Hospital el Bierzo, Ponferrada, Leon, Spain, E-Mail:
Hernandez Rodriguez JV, Garcia AR, Ramos OC (2015) Multiple Hepatic Cirrhosis Complications: Left Hepatic Hydrothorax, Upper Gastrointestinal Hemorrhage and Acute Portal Vein Thrombosis: A Case Report. Imaging J Clin Med Sciences 2(1): 002-003. DOI: 10.17352/2455-8702.000016
© 2014 Hernandez Rodriguez JV, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Hepatic hydrothorax (HH), variceal haemorrhage (VH) and portal vein thrombosis (PVT) are complications associated with hepatic cirrhosis (HC) and involve poor prognosis.
HH occurs in 4%-17% of cirrhotic patients . Atypical presentations include pleural effusion without ascites and left-sided only effusions. The pathophysiology is believed to involve defects in tendinous diaphragmatic portion. Usual treatment includes diuretics and thoracocentesis, and even transjugular intrahepatic portosystemic shunt (TIPS) and liver transplantation . Among patients with cirrhosis, due to portal hypertension (PH), varices form quite frequently (10% a year, approximately), and about a third of patients with varices will develop VH. PVT is commonly developed in cirrhosis (ultrasonography studies have reported prevalence of 5 to 24 per cent), and is related to unbalanced haemostasis and slowing of portal flow.
A 75 year old patient was admitted to our intensive care unit (ICU) because life-threatening upper digestive haemorrhage. He was diagnosed years ago of cirrhotic liver disease (CHILD B MELD 11). An upper gastrointestinal endoscopy, 6 days before admission, showed esophageal varices grade III (treated with endoscopic band ligation) and severe portal hypertension gastropathy. The patient had no previous history of cardiopathy.
After ICU admission, an upper gastrointestinal endoscopy was performed showing active bleeding from gastric fundus, and unsuccessful esclerotherapy was intended. Tracheal intubation and mechanical ventilation was required. A Sengstaken-Blakemore tube was inserted with adequate control of bleeding. Ultrasonography showed ascites and portal vein permeability.
In the routinary chest radiography a left white lung was observed. A fibrobronchoscopy was performed ruling out atelectasis associated with tracheal intubation. A thoracic tube was inserted, draining 4250 millilitres of transudate liquid in 10 hours. Despite of this, a new radiography showed no improvement in hydrothorax (Figure 1).
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