# Left-Sided Hepatic Hydrothorax in Cryptogenic Liver Cirrhosis With Portal Hypertension: A Case Report

## TL;DR

A 66-year-old woman with liver cirrhosis developed a rare left-sided hepatic hydrothorax without ascites, requiring multiple interventions before diagnosis.

## Contribution

This case report highlights a rare presentation of hepatic hydrothorax without ascites in a patient with liver cirrhosis.

## Key findings

- The patient had recurrent left-sided pleural effusion without ascites, leading to a delayed diagnosis of hepatic hydrothorax.
- Pleurodesis via video-assisted thoracic surgery was performed to improve quality of life before liver transplantation.
- The case emphasizes the importance of considering hepatic hydrothorax even in the absence of typical signs like ascites.

## Abstract

Hepatic hydrothorax is a known complication that occurs in 5-10% of patients with liver cirrhosis and is thought to account for approximately 2% of all pleural effusions. While patients with hepatic hydrothorax typically have ascites, this is not always true.

In this case report, we present a 66-year-old female, known to have liver cirrhosis, who presented with recurrent left-side unilateral pleural effusion without ascites that required frequent therapeutic tapping for symptomatic relief. Her unique presentation made the diagnosis of our case challenging, requiring extensive investigations and diagnostic and therapeutic interventions that all led to a diagnosis of a unique presentation of refractory left-sided hepatic hydrothorax. For better quality of life, pleurodesis via video-assisted thoracic surgery was performed until she was ready for liver transplantation.

Clinicians should remain vigilant about the possibility of hepatic hydrothorax despite the absence of abdominal ascites.