Hepatic hydrothorax

Hepatic hydrothorax is defined as a significant pleural effusion developing in patients with liver cirrhosis without any underlying cardiac or pulmonary disease.

Hepatic hydrothorax is mainly caused by the direct passage of fluid from the peritoneal cavity through diaphragmatic defects. These defects can vary in morphology, ranging from no obvious defect to multiple gaps in the diaphragm.

The estimated prevalence of hepatic hydrothorax is estimated at around 4-6% in patients with cirrhosis.

Risk factors for hepatic hydrothorax include advanced liver cirrhosis, prolonged disease duration, the presence of portal hypertension and ascites, and decreased pleural fluid protein concentration.

Clinical manifestation includes symptoms of dyspnea on exertion, cough, and chest discomfort. Complications include infection and respiratory distress syndrome. Spontaneous bacterial pleural empyema may complicate hepatic hydrothorax, and diagnostic thoracocentesis is recommended in patients with suspected spontaneous bacterial empyema.

The prognosis of hepatic hydrothorax is often linked to the underlying liver disease and the severity of cirrhosis. Liver transplantation remains the ultimate definitive management paradigm for these patients. Studies have shown that the presence of hepatic hydrothorax does not imply more postoperative complications, and long-term survival is similar to other indications of liver cirrhosis.