A fascinating presentation of hepatic hydrothorax

Abstract

We report this case of a 43-year-old woman with hepatitis-C cirrhosis who presented with a large right sided pleural effusion complicated by hypoxic respiratory failure and altered mentation necessitating dependence on mechanical ventilation. The pleural effusion spontaneously resolved upon initiation of mechanical positive pressure ventilation and recurred almost immediately after weaning the patient off the ventilator. The pre-ventilation, ventilation and post-ventilation chest X-ray films in chronological order present a striking visual demonstration of fluid dynamics and pathophysiology of hepatic hydrothorax, thereby obviating the need for a dedicated diagnostic test. We also report this case to highlight the treatment strategies for this often intractable complication.

Keywords: Hepatic hydrothorax; Hydrothorax; Cirrhotic pleural effusions; Refractory pleural effusions; Pleural effusions in cirrhosis

Core tip: We aim to publish this fascinating presentation of a case of hepatic hydrothorax that clearly provides an insight into pathophysiology of its development. We also presented its natural course and management. Such awareness will prompt institution of timely therapy and prevent long term sequelae of this potentially fatal condition.