Hepatitis C

Acute massive postoperative pleural effusion associated with asymptomatic hepatitis C-induced cirrhosis of the liver

The development of an acute pleural effusion during the immediate postoperative period after abdominal or pelvic surgery is not uncommon. In symptomatic patients, pleural effusions often are thought to result from a complication of pulmonary embolism or parapneumonic effusion. We present a patient in whom an acute unilateral hepatic hydrothorax developed after elective total abdominal hysterectomy. Pleural effusion continued to reaccumulate for several days. After extensive efforts failed to reveal the cause of effusion, intraperitoneal radioisotope study confirmed a peritoneopleural communication associated with unsuspected and asymptomatic hepatitis C-induced cirrhosis of the liver with portal hypertension.

Hepatitis

Hepatitis is a diagnosis that can easily be missed by the physician. The morbidity of this disease is significant when one takes into account all the cases that either do not have a typical presentation or are misdiagnosed. The emergency physician bears substantial responsibility in the diagnosis and intervention of patients with hepatitis, and needs to develop a systematic way of approaching the patient with a viral syndrome or other vague complaints that will allow appropriate consideration of this diagnosis.