Hepatic
hydrothorax is a rare complication of
portal hypertension secondary to
liver cirrhosis affecting approximately 5-10% of cirrhotic patients with
ascites. Hepatic
hydrothorax results from an accumulation of fluid migrating through a diaphragmatic defect from the abdominal cavity into the pleural cavities. The effusion of hepatic
hydrothorax is typically transudative whereas the effusion of spontaneous bacterial
empyema (SBEM) is exudative. The clinical management of hepatic
hydrothorax is equivalent to that of
ascites. Patients with persistent hepatic
hydrothorax despite fluid and
sodium restriction as well as the use of maximally tolerable doses of
diuretics and repeated thoracentesis are considered to have refractory hepatic
hydrothorax. SBEM is a frequent underlying condition. SBEM occurs in up to 13% of patients with hepatic
hydrothorax and should be treated by
antibiotic therapy. Refractory
hydrothorax is observed in 10% of patients with hepatic
hydrothorax. These patients should be considered for transjugular intrahepatic portal systemic shunt (
TIPS) placement which is the most effective option for refractory hepatic
hydrothorax with response rates ranging up to 80% in most studies. Suitable patients with hepatic
hydrothorax should be considered as candidates for
liver transplantation.
TIPS may help to bridge the time to
liver transplantation.