Management of Recurrent Transudative Effusions in Congestive Heart Failure and Hepatic Hydrothorax

Abstract

Pleural effusions are commonly present in the setting of decompensated heart failure (up to 87%) and liver failure (5%-16%). Notably, patients with decompensated congestive heart failure-induced pleural effusions have a significant 1 year mortality rate from 46% to 50%, while decompensated liver failure accompanied by hepatic hydrothorax demonstrates even higher mortality, particularly when complicated by spontaneous bacterial empyema (51% compared to 19% with refractory ascites). Diagnosis typically involves comprehensive clinical assessment alongside pleural fluid analysis. However, the management of recurrent transudative pleural effusions lacks standardized guidelines, often necessitating a multidisciplinary approach due to the nuanced nature of these cases.

Keywords: Congestive heart failure; Hepatic hydrothorax; Transudative effusion.