Author:
Woolnough Kerry,Palejwala Altav,Bramall Simon
Abstract
Abstract
Introduction
Polycystic liver disease is asymptomatic in 95% of patients. In the remaining 5% it causes symptoms due to the local mass effect of the polycystic liver. We describe the case of a patient who presented with symptoms of a pleural effusion and was also found to have polycystic liver disease. The effusion recurred despite repeated efforts at drainage and only resolved following surgical debridement of the cystic liver.
Case presentation
A 50-year-old Caucasian woman presented with a two-week history of increasing dyspnoea. An examination revealed a large right pleural effusion and gross hepatomegaly. An ultrasound confirmed a large polycystic liver and diagnostic thoracocentesis revealed an exudate, which was sterile to culture. The pleural effusion proved refractory to drainage and our patient underwent surgery to deroof the main hepatic cysts in an attempt to reduce the pressure on her right diaphragm. The histology was compatible with that of polycystic liver disease. No evidence of malignancy was found. After surgery, our patient had no recurrence of her effusion and, to date, has remained asymptomatic from her polycystic liver disease.
Conclusion
The case in this report illustrates that an exudative pleural effusion is a rare complication of polycystic liver disease. We feel that the mechanical effects of a large polycystic liver, and subsequent disruption of sub-diaphragmatic capillaries, resulted in a persistent exudative pleural effusion. Thus, surgical debulking of the hepatic cysts is required to manage these effusions.
Publisher
Springer Science and Business Media LLC
Reference9 articles.
1. Bistritz L, Tamboli C, Bigam D, Bain VG: Polycystic liver disease: experience at a teaching hospital. Am J Gastroenterol. 2005, 100 (10): 2212-2217. 10.1111/j.1572-0241.2005.50258.x.
2. Turnage RH, Eckhauser FE, Knol JA, Thompson : Therapeutic dilemmas in patients with symptomatic polycystic liver disease. Am Surg. 1988, 54 (6): 365-372.
3. Russell RT, Pinson CW: Surgical management of polycystic liver disease. World J Gastroenterol. 2007, 13 (38): 5052-5059.
4. Van Erpecum KJ, Janssens AR, Terpstra JL, Tjon A, Tham RJ: Highly symptomatic adult polycystic disease of the liver. A report of fifteen cases. J Hepatol. 1987, 5 (1): 109-117. 10.1016/S0168-8278(87)80068-5.
5. Arnold HL, Harrisson SA: New advances in evaluation and management of patients with polycystic liver disease. Am J Gastroenterol. 2005, 100 (11): 2569-2582. 10.1111/j.1572-0241.2005.00263.x.
Cited by
5 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献