Contemporary Perspectives on the Pathophysiology and Management of Hepatic Hydrothorax

Abstract

Hepatic hydrothorax is defined as a transudative pleural effusion, greater than 500 mL, in patients with portal hypertension in the absence of a primary cardiopulmonary cause. The fluid likely translocates into the pleural space from the peritoneum across the defects in the diaphragm. Owing to the physical constraints of the thoracic cavity, hydrothorax is typically more challenging to treat than ascites as patients will become symptomatic with as 500 mL of fluid is in the pleural space. Treatments include salt restriction, diuretics, periodic thoracentesis, transjugular intrahepatic portosystemic shunting, video-assisted transthoracic surgery, and pleurodesis. It is important to note that a chest tube is not mentioned in the potential treatment options and should be reserved exclusively for patients with frank pus in the pleural fluid or a pneumothorax. The ultimate treatment, though, is a liver transplant; thus, the development of hepatic hydrothorax warrants a liver transplant evaluation for appropriate candidates.