Management of hepatic hydrothorax

TIPS: Transjugular intrahepatic portosystemic shunt.
* Patients with hepatic hydrothorax who do not have contraindications to liver transplantation should be referred for a transplantation evaluation.
¶ Initial diuretic doses are furosemide 40 mg daily and spironolactone 100 mg daily. If there is no response, diuretics may be increased in a stepwise fashion every three to five days by doubling the doses. Maximum doses are furosemide 160 mg daily and spironolactone 400 mg daily.
Δ Therapeutic thoracentesis can be performed periodically in conjunction with diuretic therapy.
◊ We generally reserve TIPS for patients with Child A or Child B cirrhosis, who are younger than 70 years of age, and who do not have hepatic encephalopathy. A cardiac evaluation should be performed in patients with signs, symptoms or a history of heart failure, tricuspid regurgitation, cardiomyopathy or pulmonary hypertension.
§ We monitor TIPS patency with Doppler ultrasound between three and six months after placement and then at six month intervals for the first two years.