Hepatic hydrothorax--a rare cause of pleural effusion that is difficult to manage]

Hepatic hydrothorax is a rare but important cause of--usually unilateral--pleural effusion. Hepatic hydrothorax can be observed as a complication of portal hypertension in < 10 % of the patients with ascites secondary to advanced liver cirrhosis. The underlying pathophysiological mechanism seems to be a direct movement of fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. In rare cases complete translocation of fluid into the pleural space can be observed. We describe a 67-year-old cirrhotic patient suffering from a massive pleural effusion on the right side in the absence of any relevant ascites. Based on this case report and a review of the literature, we discuss the pathogenesis and--especially in cases characterised by a continuous accumulation of large amounts of pleural effusion--the notoriously difficult diagnostic and therapeutic management of hepatic hydrothorax. In the case described here, the intraperitoneal application of dye helped to prove that the fluid in the pleural space originated from the peritoneal cavity.