Hepatic hydrothorax in the absence of ascites in a child with autoimmune hepatitis: Successful management with octreotide and pleurodesis.

Hepatic hydrothorax is a rare complication of liver cirrhosis and portal hypertension. It carries a diagnostic and therapeutic difficulty especially if occurring in the absence of ascites. We report a nine-year-old child with autoimmune hepatitis type 1, who presented with a right-sided hepatic hydrothorax in the absence of ascites. The patient was treated successfully with diuretics, octreotide and pleurodesis together with immunosuppressive therapy for autoimmune hepatitis. There was no recurrence of effusion after a long follow-up duration. In conclusion, hepatic hydrothorax should be considered in the differential diagnosis of pleural effusion occurring in children with cirrhotic liver, whether associated with ascites or not. Octreotide as a splanchnic vasoconstrictor can be used in establishing the diagnosis and in the treatment of hepatic hydrothorax. The need for liver transplantation in such patients may be avoided when the liver disease can be treated specifically.