Hepatic hydrothorax

Hepatic hydrothorax
Chest X-ray showing a hepatic hydrothorax in a person with cirrhosis
Symptoms	Cough, shortness of breath, and respiratory failure
Causes	Liver cirrhosis, ascites
Diagnostic method	Pleural fluid analysis
Treatment	Medical management, thoracentesis, liver transplant, palliative care
Prognosis	Poor

Hepatic hydrothorax is a rare form of pleural effusion that occurs in people with liver cirrhosis. It is defined as an effusion of over 500 mL in people with liver cirrhosis that is not caused by heart, lung, or pleural disease. It is found in 5–10% of people with liver cirrhosis and 2–3% of people with pleural effusions. In cases of decompensated liver cirrhosis, prevalence rises significantly up to 90%.^[1] Over 85% of cases occurring on the right, 13% on the left, and 2% on both.^[2] Although it is most common in people with severe ascites, it can also occur in people with mild or no ascites. Symptoms are not specific and mostly involve the respiratory system.

The condition is diagnosed based on the existence of liver cirrhosis and fluid build-up in the abdomen (ascites) and analysis of the fluid. The fluid has a low protein content. Mainly, the condition is treated by medical management, such as diet adjustment and usage of diuretics. When the condition does not respond, it is known as refractory hepatic hydrothorax: treatment includes inserting a transjugular intrahepatic portosystemic shunt (TIPS). The only curative treatment is a liver transplant. The prognosis is usually unfavorable, especially in refractory cases, due to the majority of people being unsuitable for transplantation.^[3] However, transplantation indicates a favorable prognosis; one case study showed that the condition had no effect on post-transplant outcomes.^[1]