Topics in Pulmonary MedicineHepatic Hydrothorax: Diagnosis, Clinical Implications, and ManagementStahl, Jennifer L. MD; Levin, Elina MD; Brown, Craig MD; Bowling, Mark MDAuthor Information East Carolina University Division of Pulmonary and Critical Care Medicine, Brody School of Medicine, Greenville, NC Disclosure: The authors declare that they have no conflicts of interest. Address correspondence to: Craig Brown, MD, East Carolina University Division of Pulmonary and Critical Care Medicine, Brody School of Medicine, 3E-149 Greenville, NC 27834. E-mail: email@example.com. Clinical Pulmonary Medicine: September 2016 - Volume 23 - Issue 5 - p 203-209 doi: 10.1097/CPM.0000000000000172 Buy Metrics Abstract Hepatic hydrothorax is a relatively rare complication seen in patients with liver cirrhosis and portal hypertension. It can have serious consequences such as spontaneous bacterial empyema. The pathogenesis of pleural fluid accumulation is thought to be due to pleuroperitoneal blebs that rupture and cause diaphragm defects, allowing a unidirectional flow from the peritoneal to the pleural cavities. Diagnosis requires ruling out other causes of pleural effusion and evaluating for pleural infection. Treatment options aim at decreasing fluid production (salt restriction, diuretics), decompressing the portal system, and rare surgical repair of diaphragmatic defects. A wide range of management options have been proposed with no firmly established treatment of choice other than liver transplantation. Because of the limited availability of liver transplants and the large number of patients who are not transplant candidates, emphasis on symptom relief and improvement in patient morbidity and survival is vital. Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.