Treatment of Liver Cirrhosis with Hepatic Hydrothorax (Pleural Effusion)

Clinical Scenario

This protocol applies to patients with liver cirrhosis who develop hepatic hydrothorax — pleural effusion attributable to hepatic disease — in whom cardiopulmonary causes and primary pleural disease have been excluded.

Key Condition

Hepatic hydrothorax is a complication of cirrhosis characterised by pleural fluid accumulation in the absence of underlying lung or cardiac pathology. First-line management centres on diuretic therapy and thoracentesis. This protocol provides structured guidance for patients whose course extends beyond these initial measures into the refractory setting.

Treatment Approach — Partial Overview

When hepatic hydrothorax becomes refractory and liver transplantation or certain interventional alternatives are not feasible, a procedural approach targeting the pleural space or an underlying anatomical pathway may be considered in carefully selected patients. In a distinct subgroup with non-advanced disease and preserved renal function, correction of an underlying structural defect is another option addressed in the protocol.

Full selection criteria, the complete step-by-step algorithm, and all technical and patient-specific considerations are available in the structured protocol.