Hepatic hydrothorax: Pathogenesis, diagnosis, and management

Hepatic hydrothorax is defined as a pleural effusion in a patient with cirr hosis of the liver and no cardiopulmonary disease. The estimated prevalence of this often debilitating complication in patients with liver cirrhosis i s 4% to 10%. Its pathophysiology involves movement of ascitic fluid from th e peritoneal cavity into the pleural space through diaphragmatic defects. A s a result patients are at increased risk of respiratory infection. Initial management consists of sodium restriction, diuretics, and thoracentesis. A transjugular intrahepatic portosystemic shunt may be required. Because mos t patients with hepatic hydrothorax have end-stage liver disease, a liver t ransplant should be considered if these options fail. Am I Med. (C) 1999 by Excerpta Medica, Inc.