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We thank Aithal et al1 for their recent guidelines on the management of ascites in cirrhosis. We lead a pleural service in the North East of England and frequently deal with hepatic hydrothoraces (HH). We believe that the guidelines will be significantly enhanced by mentioning some figures around HH and the management so that clinicians and patients are better informed.
HH is predominantly right-sided due to diaphragmatic defects, but up to 17.5% of effusions are left and 3% bilateral. Of patients 21%–26% develop refractory HH.2 As a first-line intervention, thoracocentesis has a low complication rate (pneumothorax 0.6%–6% and haemothorax 0%–2%). Shojaee et al3 performed a case–control study of 82 patients with HH undergoing 274 thoracenteses and 100 control patients undergoing 188 thoracenteses. The complication rate was higher with repeat thoracocentesis in patients with HH (8% vs 0%, p=0.016, 95% CI …
Contributors AA had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. The study concept and design were made by AA. Acquisition of data was done by KJ and RD. KJ and RD drafted the manuscript. Critical revision and final approval of the manuscript were done by all authors.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.
Provenance and peer review Not commissioned; internally peer reviewed.
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