The burden of hepatic hydrothorax in an Egyptian tertiary hospital

Abstract

<bold>Background:</bold> Hepatic hydrothorax (HH) is a complication of liver cirrhosis characterized by pleural effusion due to translocation of ascitic fluid through diaphragmatic defects. This study aimed to assess the prevalence of HH among patients with decompensated liver cirrhosis admitted to Alexandria University Hospitals and document the drainage procedures required for symptom relief. <bold>Methods:</bold> A prospective observational study was conducted over six months, enrolling patients admitted to the Hepatology wards with decompensated cirrhosis. Data collected included demographics, cirrhosis aetiology, Child-Pugh score, ascites severity, breathlessness severity, imaging findings, and history of pleural interventions. Ultrasound was used to quantify pleural effusion, and therapeutic thoracentesis was performed when clinically indicated. <bold>Results:</bold> 99 patients were included, mean age 57.9 ± 11.4 years; 55 males (55.7%). Hepatitis C virus was the most common cirrhosis aetiology in 38% followed by bilharziasis in 17.2%. 55% had Child-Pugh score of B and 28% had score C. 75% of patients had mMRC dyspnoea score of 2-4. Based on US examination, HH was present in 30 (31.3%) patients of the overall cohort in 37.5% (30/80) of those with ascites. 53.3% of the effusions were right-sided, 43.3% bilateral and 3.4 % were left-sided. Among HH cases, 8 (26.7%) required thoracentesis during the current admission, 13 (43.3%) had undergone thoracentesis in the past 12 months, of whom 7 (23.3%) required more than one procedure. <bold>Conclusion:</bold> HH is a frequent complication of cirrhosis, affecting nearly one-third of decompensated cases. Symptomatic intervention is required repeatedly in a substantial proportion of these patients.