title: Paradigms in the management of hepatic hydrothorax: past, present, and future.
abstract: Hepatic hydrothorax (HH) is an infrequent but a well-known complication of portal hypertension in patients with end-stage liver disease. The estimated prevalence of HH is around 4-6 % in cirrhotics. Thoracentesis and pleural fluid analysis is a must for establishing the diagnosis of this transudative effusion in the absence of primary cardiopulmonary disease. Management strategies include sodium restriction, diuretics, thoracentesis, transjugular intrahepatic portosystemic shunt, pleurodesis, and video assisted thoracic surgery in selected patients. Liver transplantation remains the ultimate definitive management paradigm. Refractory HH thus warrants prompt consideration of liver transplantation.
authors.affiliation: Institute of Liver and Biliary Sciences, New Delhi, India. Sachin.drk@gmail.com.
authors.forename: Sachin
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Institute of Liver and Biliary Sciences, New Delhi, India.
authors.forename: Shiv Kumar
authors.initials: SK
authors.lastname: Sarin
keywords: Cirrhosis; Hepatic hydrothorax; Liver transplantation; Spontaneous bacterial empyema; Transjugular intrahepatic portosystemic shunt; Video-assisted thoracic surgery