Hepatic hydrothorax -- how would you manage it?

A 53-year-old woman with a history of chronic alcoholism presented with symptomatic large right-sided pleural effusion with no evidence of ascites. After a diagnosis of hepatic hydrothorax was established, her symptoms improved with therapeutic thoracentesis. She required multiple emergency department visits for recurrent right-sided pleural effusion treated with urgent therapeutic taps. Hepatic hydrothorax is a relatively infrequent but potentially serious complication of liver cirrhosis. The management of hepatic hydrothorax, usually required in symptomatic patients, is controversial and contradictory. The case summary is followed by a question regarding available management options. The pathophysiology of hepatic hydrothorax, the role of various therapeutic options and the current favoured therapy for this not so uncommon disorder are reviewed.