Hepatic hydrothorax: pathogenesis, diagnosis, and management

Am J Med. 1999 Sep;107(3):262-7. doi: 10.1016/s0002-9343(99)00217-x.


Hepatic hydrothorax is defined as a pleural effusion in a patient with cirrhosis of the liver and no cardiopulmonary disease. The estimated prevalence of this often debilitating complication in patients with liver cirrhosis is 4% to 10%. Its pathophysiology involves movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. As a result patients are at increased risk of respiratory infection. Initial management consists of sodium restriction, diuretics, and thoracentesis. A transjugular intrahepatic portosystemic shunt may be required. Because most patients with hepatic hydrothorax have end-stage liver disease, a liver transplant should be considered if these options fail.

Publication types

  • Review

MeSH terms

  • Algorithms
  • Diagnosis, Differential
  • Diaphragm / abnormalities
  • Diaphragm / surgery
  • Diuretics / therapeutic use
  • Humans
  • Hydrothorax / diagnosis*
  • Hydrothorax / drug therapy
  • Hydrothorax / etiology
  • Hydrothorax / surgery
  • Hydrothorax / therapy*
  • Liver Cirrhosis / complications*
  • Peritoneovenous Shunt
  • Pleural Effusion / complications*
  • Pleural Effusion / etiology
  • Pleurodesis
  • Portasystemic Shunt, Transjugular Intrahepatic
  • Thoracoscopy
  • Thoracostomy


  • Diuretics