Reviews
Hepatic hydrothorax: pathogenesis, diagnosis, and management

https://doi.org/10.1016/S0002-9343(99)00217-XGet rights and content

Abstract

Hepatic hydrothorax is defined as a pleural effusion in a patient with cirrhosis of the liver and no cardiopulmonary disease. The estimated prevalence of this often debilitating complication in patients with liver cirrhosis is 4% to 10%. Its pathophysiology involves movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. As 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 most patients with hepatic hydrothorax have end-stage liver disease, a liver transplant should be considered if these options fail.

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,

References (39)

  • B.G. Rosser et al.

    Thoracic duct-cutaneous fistula in a patient with cirrhosis of the liversuccessful treatment with a transjugular intrahepatic portosystemic shunt

    Mayo Clin Proc

    (1996)
  • P. Van der Linden et al.

    Pulmonary hypertension after transjugular intrahepatic portosystemic shunteffects on right ventricular function

    Hepatology

    (1996)
  • C.S. Morrow et al.

    Hepatic hydrothorax

    Ann Intern Med

    (1958)
  • R.M. Strauss et al.

    Hepatic hydrothorax

    Sem Liver Dis

    (1997)
  • W.M. Alberts et al.

    Hepatic hydrothoraxcause and management

    Arch Intern Med

    (1991)
  • Light RW. Pleural Diseases, 3rd ed. Baltimore: Williams & Wilkins,...
  • P.A. Emerson et al.

    Hydrothorax complicating ascites

    Lancet

    (1995)
  • F.L. Lieberman et al.

    Pathogenesis and treatment of hydrothorax complicating cirrhosis with ascites

    Ann Intern Med

    (1966)
  • A. Chen et al.

    Diaphragmatic defect as a cause of massive hydrothorax in cirrhosis of the liver

    J Clin Gastro

    (1988)
  • Cited by (182)

    • Pleural Effusion: Hepatic Hydrothorax

      2021, Encyclopedia of Respiratory Medicine, Second Edition
    View all citing articles on Scopus
    View full text