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Hepatic hydrothorax associated with hepatocellular carcinoma: a controversial presentation

Author: 
Quezia de Sousa Monteiro, Viviane de Carvalho, Emily dos Santos Franco, Dessana Francis Chehuan and Márcia Melo Damian
Subject Area: 
Health Sciences
Abstract: 

Hepatic hydrothorax is defined as a unilateral and mainly right-sided pleural effusion, showing a transudative pattern, non-justified by any secondary causes. Rarely, it may occur independently from and concomitantly with a hepatocellular carcinoma (HCC) with or without pulmonary metastasis, keeping its transudative features. In this article, we address the case of a 64-year-old-woman with liver cirrhosis due hepatitis C virus (genotype 2) with a large, transudative and recurring right-sided pleural effusion characterized as hepatic hydrothorax since 2013, period in which evaluation exams for hepatic cancer were negative. However, two years after the beginning of the hepatic hydrothorax, the existence of hepatocellular carcinoma was evidenced, even though the patient shows lung metastases which were found in the necropsy, and also because she made use of diuretics, in all analyzed pleural fluids – in different moments – the pleural effusion patterns remained transudative, reinforcing that the pleural effusion was due to the portal hypertension and not because of the neoplastic process. This case showed that, even though hepatic hydrothorax and hepatocarcinoma are not frequently seen together, they do not exclude each other and they need to be recognized as different disease entities which need different approaches for a better patient management.

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