Intractable Hepatic Hydrothorax: A Successful Outcome following CPAP Treatment

Hepatic hydrothorax is an uncommon complication in patients with end-stage liver disease. It may result in dyspnoea, hypoxia and infection, and carries a poor prognosis. Initial treatment is based on a sodium-free diet together with diuretics. In case of recurrent hydrothorax, a transjugular intrahepatic portosystemic shunt (TIPS) or liver transplant should be considered. Here we describe an 80-year-old woman with decompensated liver cirrhosis related to NASH who presented with refractory hepatic hydrothorax. Treatment with CPAP resulted in a marked improvement in her pleural effusion. LEARNING POINTS: Hydrothorax is uncommon, occurring in up to 4–6% of all patients with cirrhosis and in up to 10% of patients with decompensated cirrhosis. Hepatic hydrothorax can be refractory to diuretics and salt restriction. CPAP may be an interesting alternative treatment.