Hepatic hydrothorax: The shower within.

Hepatic hydrothorax (HH) is an infrequent but a well-known complication of portal hypertension. Transdiaphragmatic passage of ascitic fluid from peritoneal to the pleural cavity through numerous diaphragmatic defects has been shown to be the predominant mechanism in the formation of HH. Medical management of this condition often fails, and there are no large randomized-controlled trials establishing the best treatment strategies. HH thus represents a formidable entity in the management of end-stage liver disease, and the only definitive treatment is liver transplantation. However, in selected group of patients, medical thoracoscopy not only helps in establishing the diagnosis but can also be used as an effective management strategy, especially in patients awaiting liver transplantation.