An Acute Hepatic Hydrothorax Causing Tension

Patients with advanced cirrhosis are at risk for numerous complications, including hepatic hydrothorax. Hepatic hydrothorax most commonly occurs in the right pleural space but less commonly can present on the left hemithorax. The exact pathophysiology is not fully understood, but there are several schools of thought for right-sided effusions. In this case report, we discuss the findings of a 76-year-old female who experienced a left-sided hydrothorax likely stemming from her underlying liver disease which created tension pathology in an otherwise stable patient. Interestingly, this accumulation occurred over a couple of weeks despite optimal medical management. A thoracentesis confirmed ascitic fluid. In the final stages of hepatic failure, pleural effusions are typically found and are associated with a higher mortality rate.