Comparison of treatment of hepatic hydrothorax with catheter drainage versus serial thoracentesis

Hepatic hydrothorax is a nonmalignant pleural effusion associated with portal hypertension that may cause increased morbidity or mortality in cirrhotic patients. For patients who are refractory to salt restriction and diuretics, thoracentesis and catheter drainage are necessary for symptomatic relief. This review aimed to identify the best drainage method in patients with hepatic hydrothorax.

Chest tube placement is discouraged in cases of hepatic hydrothorax due to high complication and mortality rates. Although the complication rate associated with smaller caliber catheter drainage appears lower than with chest tube drainage, patients treated with catheter drainage still had a higher 30-day mortality compared with patients treated by thoracentesis. Catheter drainage was an independent risk factor for 30-day mortality in cirrhotic patients with pleural effusion after adjusting for age, hepatic dysfunction, and other comorbidities. Treating the underlying disorder with liver transplantation can dramatically improve survival in these patients.

The recent evidence supports series thoracentesis as the first-line drainage method in cases of hepatic hydrothorax compared with catheter drainage. Further prospective, randomized, controlled trials are necessary to further evaluate the mortality and complication rates of catheter drainage compared with thoracentesis in cirrhotic patients.