Hepatic
hydrothorax was diagnosed in four patients with
liver cirrhosis, three men aged 65, 41, and 48 and a woman aged 48. They presented with either right-sided or bilateral pleural-fluid accumulations in the absence of cardiopulmonary disease. In the first man with no concurrent
ascites, the disorder was missed, resulting in prolonged
chest tube drainage, multiple severe complications and death. In the 41-year-old man
chest tube drainage was also associated with complications including
renal failure and
encephalopathy.
Pleurodesis was effective in the woman while in the remaining man hepatic
hydrothorax was only a temporary, asymptomatic finding.
Pleural effusions in cirrhotic patients should be considered and managed as hepatic
hydrothorax unless diagnostic studies reveal a different aetiology. Absence of
ascites is not uncommon and should not delay the correct diagnosis. The gradient between pleural and
serum albumin concentration is typically more than 11 g/l. Prolonged
chest tube drainage is dangerous and should be avoided. In cases refractory to
salt restriction and
diuretic therapy, transjugular introduction of an intrahepatic
portosystemic shunt is the treatment of choice. Recently,
pleurodesis combined with thoracoscopic repair ofdiaphragmatic defects has been reported as a potentially effective form of
therapy.