Hepatic Hydrothorax in Decompensated Cirrhosis: A Case Based Narrative Review of Management Challenges and Strategies

In Sri Lanka, liver transplantation is rarely performed for decompensated cirrhosis. Hepatic hydrothorax (HH) is a rare yet significant complication of decompensated cirrhosis, affecting approximately 5–10% of patients with portal hypertension. It results from ascitic fluid shifts through diaphragmatic defects, resulting in pleural effusions, mainly on the right side. HH is often refractory to standard diuretic therapy and poses considerable management challenges due to the lack of local consensus guidelines. This narrative review discusses the clinical complexities encountered in two patients with HH and highlights key management considerations, including the effective diuresis and mitigation of other associated complications along with meticulous fluid management strategies; yet ultimately emphasizing liver transplantation as the definitive treatment along with other possible therapeutic strategies.