SHM Converge Scientific Abstract ePoster Gallery-Hepatic Hydrothorax in a Patient With Minimal Ascites

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This case describes a 62-year-old woman with end-stage liver disease from autoimmune hepatitis who presented with two days of dyspnea and cough. She was found to have recurrent right-sided pleural effusions, mild hypoxia, bilateral leg edema, and crackles at the right lung base. Initial evaluation suggested possible congestive heart failure because of an elevated BNP and recurrent effusion, so she was admitted for thoracentesis and IV diuresis.<br /><br />Pleural fluid studies indicated a transudative process. However, despite diuretic optimization, the pleural effusion kept recurring, leading to repeated hospitalizations and further work-up. Cardiac and pulmonary causes were excluded: transthoracic echocardiogram was unremarkable, CT pulmonary angiography showed no pulmonary embolism, and right heart catheterization demonstrated normal right-sided pressures even though the patient appeared volume overloaded clinically. Imaging of the abdomen showed cirrhosis with minimal to no ascites.<br /><br />After consultation with gastroenterology, cardiology, and pulmonology, the effusion was determined to be most consistent with hepatic hydrothorax. The patient was offered serial thoracenteses, oral diuretic optimization, and planned outpatient TIPS evaluation for refractory disease.<br /><br />The report emphasizes that hepatic hydrothorax is a diagnosis of exclusion, typically seen in cirrhotic patients with pleural effusions, usually on the right side. Although most patients have large-volume ascites, this case adds to literature showing that hepatic hydrothorax can occur even with minimal ascites. Portal hypertension alone may be enough to cause the condition. The authors note that hospitalists are well positioned to recognize and manage hepatic hydrothorax in patients with decompensated cirrhosis and unexplained unilateral pleural effusions.

Asset Subtitle

Meygan J. Lackey Elway

Meta Tag

Author List Ernesto R. Barbosa MD, Meygan J. Lackey Elway, Patricia Giunta, Yildirim Ozedemir MD

Category Clinical Vignettes

Concept Hepatic Hydrothorax

Concept Pleural Effusion

Concept Portal Hypertension

Concept MELD

Concept Diagnosis of Exclusion

Distinguished Non-Finalist

Presenter Organization Boston University/Boston Medical Center

Presenting Author Meygan J. Lackey Elway

Track Adult

Keywords

hepatic hydrothorax

cirrhosis

autoimmune hepatitis

right-sided pleural effusion

transudative pleural fluid

dyspnea

thoracentesis

portal hypertension

TIPS

decompensated liver disease

Hepatic Hydrothorax

Pleural Effusion

Portal Hypertension

MELD

Diagnosis of Exclusion