ReviewsHepatic hydrothorax: pathogenesis, diagnosis, and management
Section snippets
Definition and pathogenesis
H epatic hydrothorax is defined as a significant pleural effusion, usually greater than 500 mL, in a patient with cirrhosis of the liver but no primary cardiac or pulmonary disease 1, 2. Its development is not associated with any particular cause of cirrhosis, although many patients have alcoholic cirrhosis (3).
In patients with hepatic hydrothorax, even a modest volume of pleural fluid can cause respiratory symptoms, in contrast to ascites, where a large volume can be well tolerated. This is
Management
Patients with hepatic hydrothorax usually have advanced liver disease and are potential candidates for orthotopic liver transplantation. The aim of therapy in such patients should be to relieve symptoms and prevent pulmonary complications until a transplant can be performed.
Treatment recommendations
We recommend that patients with liver disease and symptomatic pleural effusion should be assessed for cardiopulmonary causes of pleural effusion with a history, physical examination, pleural fluid analysis, chest radiography, and echocardiography (Figure). Those results and the clinical setting may warrant computed tomography of the chest, pleural biopsy, or more detailed cardiac evaluation. If hepatic hydrothorax is diagnosed, the liver should be evaluated by ultrasound for size, structure,
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