By Prof.Mohamed Farrag
It should be suspected in all patients with cirrhosis or portal hypertension and an undiagnosed pleural effusion, regardless of the presence of ascites. Diagnostic thoracentesis should be performed to exclude alternative etiologies, especially infection. Computed tomography may be useful in assessing any underlying pleural or pulmonary disease. Patients with confirmed hepatic hydrothorax should be referred for liver transplantation if they are otherwise suitable candidates. We recommend that all patients be counseled on avoidance of alcohol and NSAIDs, a low sodium diet, and receive appropriate doses of diuretics We suggest a therapeutic thoracentesis be performed in patients who are severely symptomatic and in those who do not tolerate diuretics زWe suggest TIPS(transjagular intrahepatic portosystemic anastemosis) in patients who require repeated thoracentesis provided that they are selected carefully We generally suggest TIPS for patients with a Child-Pugh score less than 10 who are younger than 60 and who do not have hepatic encephalopathy. The MELD score can also be helpful for guiding patient selection. We suggest pleurodesis and/or repair of the diaphragm in patients who are not eligible for TIPS and in whom more conservative measures have been unsuccessful زWe recommend against placement of a chest tube since can be associated with severe complications.