Hepatic hydrothorax
Hepatic hydrothorax is a rare form of pleural effusion that occurs in people with liver cirrhosis. It is defined as an effusion of over 500 mL in people with liver cirrhosis that is not caused by heart, lung, or pleural disease. It is found in 5–10% of people with liver cirrhosis and 2–3% of people with pleural effusions. It is much more common on the right side, with 85% of cases occurring on the right, 13% on the left, and 2% on both. Although it is most common in people with severe ascites, it can also occur in people with mild or no ascites. Symptoms are not specific and mostly involve the respiratory system.
| Hepatic hydrothorax | |
|---|---|
| Chest X-ray showing a hepatic hydrothorax in a person with cirrhosis | |
| Symptoms | Cough, shortness of breath, and respiratory failure |
| Causes | Liver cirrhosis, ascites |
| Diagnostic method | Pleural fluid analysis |
| Treatment | Medical management, thoracentesis, liver transplant, palliative care |
| Prognosis | Poor |
The condition is diagnosed based on the existence of liver cirrhosis and fluid build-up in the abdomen (ascites) and analysis of the fluid. The fluid has a low protein content. Mainly, the condition is treated by medical management, such as diet adjustment and usage of diuretics. Cases which do not respond, known as refractory hepatic hydrothorax, the condition is treated with a transjugular intrahepatic portosystemic shunt (TIPS). The only curative treatment is a liver transplant. Prognosis is usually poor.