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Case report
Acute tension hydrothorax in chronic liver disease secondary to spontaneous diaphragmatic rupture
  1. Kevin Joseph Tharappel,
  2. Nandakrishna Bolanthakodi,
  3. Sudha Vidyasagar and
  4. Muralidhar Varma
  1. Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India
  1. Correspondence to Dr Nandakrishna Bolanthakodi; nandaksb{at}


Pleural effusion in liver cirrhotics is more commonly transudative. A transudative pleural effusion secondary to ascites in decompensated cirrhosis is also known as hepatic hydrothorax and is usually due to fluid seepage through congenital pores in the diaphragm. The patient, a known case of decompensated chronic liver disease, presented with a massive, left-sided, rapidly accumulating and transudative pleural effusion secondary to spontaneous diaphragmatic rupture. Clinically, he developed sudden onset shortness of breath and became hypotensive. This is a rare entity, and was confirmed on CT thorax revealing a focal segment defect ~1.6 cm over the left hemidiaphragm. Ascites treatment consisting of diuretics with salt restriction and repeated thoracentesis with albumin replacement improved his symptoms and lead to a complete resolution of the effusion.

  • alcoholic liver disease
  • respiratory medicine
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  • Contributors SV and MV designed and edited the report and were involved in case management. KJT and NB wrote the manuscript and were involved in case management.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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