Multidisciplinary Management of Hepatic Hydrothorax in 2020: An Evidence‐Based Review and Guidance

Recurrent hydrothorax due to diaphragmatic perforation post hepatocellular carcinoma radiofrequency ablation: A case report

“…Hepatic hydrothorax is the presence of pleural effusion in a patient with cirrhosis without evidence of cardiopulmonary disease. It occurs in 5% -15% of patients with cirrhotic portal hypertension and is associated with high mortality [1].…”

Reply:

“…We agree with the step‐up approach provided by Kulkarni et al but reiterate that data on the use of vasoconstrictors, including midodrine and terlipressin, and use of the alpha pump are limited. As noted in our review, ( 1 ) transjugular intrahepatic portosystemic shunt should be considered in eligible patients who fail medical therapy, in those who are not candidates for liver transplant, or as a bridge to transplant. In summary, we thank Kulkarni et al for their commentary and agree with them on the need for large, well‐designed studies to help guide the multidisciplinary treatment approach for this complex disease.…”

“…We agree with Kulkarni et al on the potential role of splanchnic and peripheral vasoconstrictors in the treatment of HH. In our review, ( 1 ) we summarize the sparse data on octreotide and terlipressin in HH management. However, there are currently no large studies or randomized trials on the use of these medications in HH, and evidence for their use is limited to case reports and case series.…”

“…We thank Kulkarni et al for their insightful comments on the multidisciplinary management of hepatic hydrothorax (HH), ( 1 ) and for sharing their thoughts on the role of midodrine and alpha pump in the management of HH.…”

Letter to the Editor: Midodrine for Hepatic Hydrothorax

“…However, the duration of therapy required for hydrothorax with vasoconstrictors is unknown. ( 1 ) We eagerly await the results of midodrine therapy for hepatic hydrothorax (NCT03645642).…”