A case of refractory hepatic hydrothorax complicated with spontaneous bacterial empyema in a type C liver cirrhosis patient, successfully treated with transjugular intrahepatic portosystemic shunt

Abstract

A 69 years old male, having suffered from decompensated liver cirrhosis caused by hepatitis C virus (HCV) infection, was admitted to our hospital for fever and dyspnea. On admission, massive right pleural effusion was found by X-ray and massive ascites by ultrasound. Puncture study revealed that the pleural effusion was brown and turbid (i.e., an exudate type), while the ascites was yellow and clear (a transudate type), suggesting the diagnosis of spontaneous bacterial empyema (SBEM); namely a hepatic hydrothorax complicated with bacterial infection. Since the SBEM in this patient was hardly improved by diuretics and antibiotics alone, we added a treatment with transjugular intrahepatic portosystemic shunt (TIPS). After the TIPS insertion, despite a very transient hepatic encephalopathy, both the pleural effusion and ascites gradually decreased. Now at 23 months after the TIPS, the patient is free from any of the pleural effusion and ascites. Here we report our own case suggesting the effectiveness of TIPS in SBEM, a disease with poor prognosis in general. © 2007 The Japan Society of Hepatology.