Refractory Hepatic Hydrothorax in the Absence of Ascites as a First Sign of Cirrhosis.

Hepatic hydrothorax (HH) occurs in 5-10 percent of patients with cirrhosis and usually develops in conjunction with ascites. We report a case of refractory right sided pleural effusion which turned out to be HH in the absence of ascites or previous history of cirrhosis. HH is thought to occur in isolation due to the superior absorptive capacity of the peritoneum as compared to the pleura.