A 62-year-old female patient with left-sided pleural effusion

Abstract

Hepatic hydrothorax is defined as a pleural effusion in patients with liver cirrhosis without primary cardiac, pulmonary or pleural disease. It is a rare but important cause of unilateral–pleural effusion. The prevalence of this complication is 5–10% of the total number of patients with advanced stages of cirrhosis. In most cases (85%), the effusion is right-sided; however, in 13% of cases it can be left-sided and bilateral in 2% of the cases. We present a case of left-sided hepatic hydrothorax in the absence of ascites in a patient with primary biliary cirrhosis. The diagnosis of cirrhosis was confirmed by the biopsy; the patient didn’t have any history or any signs or symptoms of cirrhosis prior to her presentation. In the case described, the patient was treated with spirnolactone, furosemide and ursodeoxycholic acid. At follow-up after six months since the diagnosis, she was responding to treatment with no complications. This case emphasizes the importance of considering hepatic hydrothorax as an etiology of a transudative pleural effusion regardless of the presence or absence of ascites in patients with occult cirrhosis.

Keywords::

• ascites
• hepatic hydrothorax
• pleural effusion
• primary biliary cirrhosis

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Erratum

Financial & competing interests disclosure

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending or royalties.

No writing assistance was utilized in the production of this manuscript.

Key issues

• • When evaluating a patient with an idiopathic transudative pleural effusion, occult liver cirrhosis should be considered in the differential diagnosis.

• • Hepatic hydrothorax is an important cause of unilateral transudative pleural effusion that occurs in 5–10% of patients with end-stage liver disease and cirrhosis.

• • Although ascites is generally present in rare cases, hepatic hydrothorax may occur in the absence of ascites and may present as a left-sided pleural effusion.

• • Treatment should be individualized based on the patient’s response to conservative management and severity of the underlying liver disease.

• • Patients with advanced liver disease and hepatic hydrothorax should be evaluated for possible liver transplantation.