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Hepatic Hydrothorax: A Review.

Abdellatif Ismail1, Mohanad Awadalla2, Suvisesh Pothuraju3

  • 1Department of Internal Medicine, University of Maryland Medical Center Midtown Campus, Baltimore, MD, USA.

Current Hepatology Reports
|September 8, 2025
PubMed
Summary
This summary is machine-generated.

Hepatic hydrothorax, a serious complication of decompensated cirrhosis, predicts mortality. Early evaluation for liver transplantation can reduce post-transplant mortality in these patients.

Keywords:
AscitesDecompensated CirrhosisHepatic HydrothoraxPleural EffusionSpontaneous Bacterial Pleuritis

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Area of Science:

  • Hepatology
  • Pulmonology
  • Critical Care Medicine

Background:

  • Hepatic hydrothorax is pleural effusion in patients with decompensated liver cirrhosis.
  • It is associated with high morbidity and mortality.
  • It occurs without primary pleural or cardiopulmonary pathology.

Purpose of the Study:

  • To review the epidemiology, pathogenesis, diagnosis, and management of hepatic hydrothorax.
  • To highlight its significance as a predictor of mortality.
  • To discuss management strategies, including liver transplantation.

Main Methods:

  • Review of existing literature on hepatic hydrothorax.
  • Analysis of diagnostic criteria, including pleural fluid analysis.
  • Evaluation of management approaches and outcomes.

Main Results:

  • Refractory hepatic hydrothorax independently predicts mortality in decompensated cirrhosis.
  • Model for End-Stage Liver Disease exception points for refractory hepatic hydrothorax reduce post-liver transplant mortality.
  • Pathogenesis involves fluid shifts from the peritoneal to thoracic cavity due to fluid retention.

Conclusions:

  • Hepatic hydrothorax management is complex, requiring a stepwise, multidisciplinary approach.
  • Diagnosis involves pleural fluid analysis and exclusion of other causes.
  • All patients with refractory hepatic hydrothorax warrant evaluation for liver transplantation.