Hepatic Hydrothorax: A Concise Review of Literature

Hepatic hydrothorax (HH) is defined as an excessive transudative pleural effusion associated with portal hypertension without cardiac, pulmonary and pleural disease, with volume of more than 500 ml. The underlying mechanisms of HH are similar to those that cause fluid accumulation and ascites in portal hypertension. Several theories have been proposed as the mechanism of developing HH, including displacement of peritoneal fluid into the pleural cavity through diaphragmatic defects, hypoalbuminemia resulting in decreased colloid osmotic pressure, and lymphatic leakage from the thoracic duct. The management of HH cases is considered difficult, so that in most cases, the management of HH follows the ascites protocol in portal hypertension. There are several principles of therapy in cases of HH, which are reducing the production of ascitic fluid, preventing the movement of ascites through diaphragm, and drainage of the pleural cavity.