title: Management of refractory hepatic hydrothorax.
abstract: OBJECTIVE
  Treatment of hepatic hydrothorax is challenging because of its rapid symptomatic recurrence. This review will focus on potential therapeutic approaches to hepatic hydrothorax.
  
  
  RESULTS
  Hepatic hydrothorax is refractory to salt restriction and diuretics in approximately 25% of cases. Primary management options for these patients include serial thoracenteses, transjugular intrahepatic portosystemic shunt (TIPS) placement, and insertion of an indwelling pleural catheter (IPC). Response rate to TIPS, being the first choice whenever possible, is about 80%. IPC is emerging as a feasible alternative in patients who require frequent therapeutic thoracenteses, particularly if TIPS is contraindicated. Pleurodesis is not advocated because of the low likelihood of a pleural symphysis owing to the rapid re-accumulation of pleural fluid. The only cure for hepatic hydrothorax, a defined complication of end-stage liver disease, is liver transplantation.
  
  
  CONCLUSIONS
  No single treatment option for refractory hepatic hydrothorax is ideal. However, in patients with contraindications to or who are awaiting liver transplantation, TIPS seems the most beneficial therapy, whereas IPC promises to be an alternative second-line consideration.
authors.affiliation: Department of Internal Medicine, Pleural Diseases Unit, Arnau de Vilanova University Hospital, Biomedical Research Institute of Lleida, Lleida, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Porcel
mesh_terms: D000319:Adrenergic beta-Antagonists / Q000009:adverse effects; D002408:Catheters, Indwelling; D004232:Diuretics / Q000627:therapeutic use; D006801:Humans; D006876:Hydrothorax / Q000209:etiology / Q000628:therapy*; D008107:Liver Diseases / Q000150:complications*; D010996:Pleural Effusion / Q000209:etiology / Q000628:therapy*; D018700:Pleurodesis; D019168:Portasystemic Shunt, Transjugular Intrahepatic / Q000379:methods; D011379:Prognosis; D012008:Recurrence; D012982:Sodium, Dietary / Q000009:adverse effects; D016896:Treatment Outcome
chemical_list: D000319:Adrenergic beta-Antagonists; D004232:Diuretics; D012982:Sodium, Dietary