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

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.