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The Egyptian Journal of Bronchology
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  • Interventional Bronchology and pulmonology
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Ultrasound-guided pleurodesis with doxycycline in patients with hepatic hydrothorax

Egyptian Journal of Bronchology volume 10, pages 20–25 (2016)Cite this article

Abstract

Background

Pleural effusion is a relatively uncommon complication of end-stage liver disease, which occurs in less than 10% of the patients. Patients with refractory hydrothorax require more invasive management with options such as repeated thoracentesis in selected patients, which usually carries risk for pneumothorax and contamination. Many studies have shown that doxycycline pleurodesis is an effective and safe method for achieving apposition of the pleural surfaces.

Patients and methods

This prospective study included 60 patients with hepatic hydrothorax. All patients were subjected to repeated thoracentesis (two to four times) followed by the placement of a 16-G cannula under ultrasound guidance for proper drainage of any detected remnants of pleural fluid collections. In total, 10 ml of lidocaine 2% were injected in the pleural space followed by 1000 mg of doxycycline diluted in 100 ml saline solution. Pleurodesis session was repeated after 1 week if any radiological evidence for reaccumulation was noticed.

Results

The sclerotherapy procedure was successful in 46 out of 60 cases (76.7%); the success rate was 72.2% in massive effusion and reached 83.3% in moderate effusion. A total of 26 patients (43.3%) had to repeat the procedure for a second time, 14 of which (23.3%) failed despite the second trial and 12 cases (20%) showed no fluid reaccumulation.

Conclusion

Ultrasound-guided doxycycline sclerotherapy is an effective approach for a successful pleurodesis in hepatic hydrothorax (overall rate of 76.7%). The procedure is safe and precludes the need for intercostal tube insertion and thus offering less discomfort for patients.

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Authors and Affiliations

  1. Department of Chest, Faculty of Medicine, Cairo University, 4 Esraa St., Cairo, Agouza, Giza, 12656, Egypt

    Ahmed M. Abd El Hafeez (MD)

  2. Department of Tropical Medicine, Faculty of Medicine, Cairo University, Cairo, Egypt

    Waleed F. Fathallah

Authors
  1. Ahmed M. Abd El Hafeez
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  2. Waleed F. Fathallah
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Correspondence to Ahmed M. Abd El Hafeez.

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Abd El Hafeez, A.M., Fathallah, W.F. Ultrasound-guided pleurodesis with doxycycline in patients with hepatic hydrothorax. Egypt J Bronchol 10, 20–25 (2016). https://doi.org/10.4103/1687-8426.176661

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