Hepatic hydrothorax: current approaches to diagnosis and therapy

Hepatic hydrothorax (HH) is a troublesome pulmonary complication that can arise in end-stage liver disease patients and can significantly impair patient quality of life and functional ability. The presence of portal hypertension, the accumulation of ascites, and subsequent fluid translocation through diaphragmatic fenestrations underlies this complication. Other pleural effusion etiologies must be excluded to ensure alternative diagnoses are not the pleural effusion source. Once attributed to HH, management and an optimal patient outcome can be difficult to achieve. This review will discuss the current understanding and various approaches to HH management, with a focus on intrathoracic interventions for this vexing clinical problem.