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VOLUME 3 , ISSUE 1 ( January-April, 2024 ) > List of Articles


Hepatic Hydrothorax in the Background of Minimal or No Ascites: A Case Report

Ketan Agarwal, Vishnu Shankar Ojha, Ratnadeep Biswas, Divendu Bhushan

Keywords : Ascites, Case report, Exudates and transudates, Hepatic hydrothorax, Pleural effusion, Portal hypertension

Citation Information : Agarwal K, Ojha VS, Biswas R, Bhushan D. Hepatic Hydrothorax in the Background of Minimal or No Ascites: A Case Report. 2024; 3 (1):23-25.

DOI: 10.5005/jp-journals-10089-0081

License: CC BY-NC 4.0

Published Online: 30-04-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim and background: Chronic liver disease (CLD) is a progressive deterioration of liver function that usually remains asymptomatic for long periods of time. An uncommon complication of long-standing portal hypertension with end-stage liver disease is hepatic hydrothorax. Case description: Here, we present an unusual case of an asymptomatic CLD patient presenting with sudden onset dyspnea. The chest X-ray showed pleural effusion in the right middle and lower zones. Biochemical analysis of the pleural fluid confirmed the transudative nature of the fluid. Minimal ascites were noted, which could not be tapped. A diagnosis of hepatic hydrothorax was made, and the patient showed marked improvement following the initiation of therapy with diuretics and β-blockers. Conclusion: Negative intrathoracic pressure in the pleural cavity during inspiration, coupled with the presence of small fenestrations in the diaphragm and the transdiaphragmatic lymphatics, favors the flow of fluid across these fenestrations and into the pleural cavity leading to hepatic hydrothorax. Clinical significance: The absence of ascites should not be used as a criterion to preclude a diagnosis of hepatic hydrothorax. Timely interventions, including both medical and surgical modalities, should be initiated for its management, but the patient may ultimately require liver transplantation.

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