A Rare Presentation of Right-Sided Pleural Effusion in Decompensated Chronic Liver Disease Secondary to Hepatitis C Infection: A Case Report.

Hepatic hydrothorax (HH) is an infrequent and clinically important complication of decompensated liver cirrhosis. It occurs in around 5%-10% of affected people. Hepatic hydrothorax is basically a transudative pleural effusion, usually right-sided and commonly without evidence of primary cardiopulmonary or renal pathology. We present the case of a 73-year-old female patient with poorly monitored hepatitis C virus (HCV) infection presenting to the hospital with progressive abdominal distension, shortness of breath, and upper GI bleeding. A decade ago, she had been diagnosed with HCV infection but had never undergone posttreatment testing to confirm viral clearance. On clinical examination, she showed signs of decompensated cirrhosis. Chest X-ray showed significant right-sided pleural effusion, while abdominal ultrasound supported chronic liver disease with portal hypertension, and a suspicious hepatic lesion was noted. Pleural fluid analysis showed low protein, low LDH, and a high serum-ascites albumin gradient, consistent with a transudative effusion as seen in HH. Infectious, malignant, cardiac, and renal causes were excluded. MRI of the liver and testing for alpha-fetoprotein were also advised for the evaluation of hepatocellular carcinoma. The present case points out the difficulties in diagnosing HH, particularly in patients where many complications of cirrhosis can present simultaneously, and further stresses that any other cause of pleural effusion needs to be thoroughly excluded. It also raises the need for long-term follow-up in HCV patients; a poor follow-up program could result in late presentation with advanced liver disease and its complications. Early diagnosis of HH and a multidisciplinary approach are fundamental to optimizing outcomes and retarding disease progression.