Effective Management of Refractory Hepatic Hydrothorax With Hypertonic Glucose Pleurodesis

Hepatic hydrothorax presents a significant challenge in advanced liver cirrhosis management, especially when conventional therapies fail. We report a case of a 66-year-old male with hepatitis C-related cirrhosis and advanced hepatocellular carcinoma who developed refractory left-sided hepatic hydrothorax despite maximal diuretic therapy. After failed talc pleurodesis, we employed an alternative approach using 50% glucose solution as a sclerosing agent. Following three sessions of hypertonic glucose pleurodesis, the patient achieved sustained resolution of pleural effusion with only minor, transient complications including hypotension and mild inflammatory response. Notably, he did not develop significant renal dysfunction or hepatic decompensation, complications commonly associated with conventional sclerosing agents in liver cirrhosis. Two-month follow-up imaging confirmed persistent pleural adhesion. This case highlights hypertonic glucose pleurodesis as a potentially safer alternative for managing refractory hepatic hydrothorax, particularly in patients unsuitable for transjugular intrahepatic portosystemic shunt or liver transplantation. However, further research is needed to establish optimal protocols, patient selection criteria, and long-term outcomes of this approach.