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      "@value" : "Hepatic hydrothorax is an infrequent complication of cirrhosis\nand symptoms are mainly related to shortness of\nbreath, cough and chest discomfort. A number of different\npathogenetic mechanisms have been postulated for the development\nof pleural effusions in cirrhotic patients. Spontaneous\ninfection of the pleural fluid, defined as spontaneous\nbacterial empyema, is a serious complication characterized\nby high mortality rate. Diagnosis is based on high\nclinical suspicion and initial therapy of hepatic hydrothorax\nis aimed at suppressing the production of ascites with\nadministration of diuretics and restriction of sodium intake.\nWhen these fail (10% of cases) and thoracentesis is\nrequired every 2-3 weeks, the hydrothorax is defined as refractory\nand alternative more aggressive therapeutic strategies,\nsuch as thoracoscopic repair of diaphragmatic defects\nwith pleural sclerosis, transjugular percutaneous intrahepatic\nporto-systemic shunt placement (TIPSS) and\nliver transplantation, must be considered.\nKey words: Hepatic Hydrothorax, spontaneous bacterial\nempyema, hepatic cirrhosis, TIPSS"
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