title: Hepatic hydrothorax without ascites as the first sign of liver cirrhosis.
abstract: A 60-year-old woman without a history of liver diseases, but with a history of regular alcohol consumption, presented with a right-sided transudative pleural effusion. Neither parenchymal lung lesion nor pleural thickening was seen on a chest computed tomography. On abdominal ultrasonography, the liver size and contour were normal, and ascites was not noted. Despite performing imaging and laboratory studies, we could not find a cause of the pleural effusion. Thus, due to her history of regular alcohol consumption, we decided to measure liver stiffness using a transient elastography (Fibroscan(®), Echosens(TM), Paris, France), which showed a value of 35.3 kPa suggestive of liver cirrhosis. An intraperitoneal injection of a radioisotope demonstrated the transdiaphragmatic flow of fluid from peritoneal cavity to pleural cavity. The diagnosis was confirmed as hepatic hydrothorax. Management consisting of restricted salt and water intake with diuretics resulted in resolution of the hepatic hydrothorax.
authors.affiliation: Division of Pulmonary and Critical Care Medicine Inha University College of Medicine Incheon Republic of Korea.
authors.forename: Jung Soo
authors.initials: JS
authors.lastname: Kim
authors.affiliation: Division of Allergy Medicine, Department of Internal Medicine Inha University College of Medicine Incheon Republic of Korea.
authors.forename: Cheol-Woo
authors.initials: CW
authors.lastname: Kim
authors.affiliation: Division of Pulmonary and Critical Care Medicine Inha University College of Medicine Incheon Republic of Korea.
authors.forename: Hae-Seong
authors.initials: HS
authors.lastname: Nam
authors.affiliation: Division of Pulmonary and Critical Care Medicine Inha University College of Medicine Incheon Republic of Korea.
authors.forename: Jae Hwa
authors.initials: JH
authors.lastname: Cho
authors.affiliation: Division of Pulmonary and Critical Care Medicine Inha University College of Medicine Incheon Republic of Korea.
authors.forename: Jeong-Seon
authors.initials: JS
authors.lastname: Ryu
authors.affiliation: Division of Pulmonary and Critical Care Medicine Inha University College of Medicine Incheon Republic of Korea.
authors.forename: Hong Lyeol
authors.initials: HL
authors.lastname: Lee
keywords: Ascites; hepatic hydrothorax; liver cirrhosis; transient elastography
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