ABSTRACT
Incidence 407 Etiology 408 Clinical presentation408 Diagnosis 408
Treatment 409 Complications: Spontaneous bacterial empyema411 Future directions 412 References 412
Hepatic hydrothorax (HH) is dened as the pleural eusion of hepatic cirrhosis and portal hypertension without a primary cardiac, pulmonary, or pleural disease.1-5 HH is an uncommon manifestation of portal hypertension and normally appears in patients with ascites, as the source of the pleural uid is ascites that crosses the diaphragm. However, the presence of ascites is not necessary for the diagnosis. Pleural uid of cirrhotic patients can become infected and spontaneous bacterial empyema (SBEM) is dened as the infection of a preexisting hydrothorax without a subjacent pneumonia.6,7
HH accounts for 2%–3% of all pleural eusions.8,9 In a report from China,10 132 out of 862 cirrhotic patients (15%) had pleural eusion although in most cases eusion was only detected by ultrasonography, and thoracentesis could only be performed in 56 (6.5%). e incidence in the four larger cases of cirrhotic patients with ascites11-14 including 1155 cases was 6%. As many as 20% of patients with HH have no clinically detectable ascites.15-17
In a recompilation of 204 reported cases of HH18 in which the side of the eusion was specied, 162 (79.5%) were rightsided, 36 (17.5%) were le-sided, and only 6 (3%) were bilateral. In a recent report of pleural eusions of cardiac origin, they were bilateral in 61% of cases, 27% unilateral on the right, and 12% unilateral on the le side.19 HH is the second cause in frequency of transudative pleural eusions and should be suspected when a transudative pleural eusion is unilateral and right-sided.
