eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2017-05-22 5 4 104 106 10.12691/ajmcr-5-4-7 AJMCR2017547 article Ganesh Kasinathan ganeshkasinathan11@hotmail.com 1 Naganathan Pillai 2 Department of Internal Medicine, Segamat Hospital, KM 6 Jalan Genuang, 85000 Segamat, Johor, Malaysia Department of Internal Medicine, Monash University Malaysia, Bandar Sunway, Malaysia Hepatic hydrothorax is defined as significant pleural effusion greater than 500 ml in a patient with liver cirrhosis without any underlying pulmonary, cardiac and pleural disease. This case report describes a 47 year old Indian gentleman who was diagnosed as alcohol induced liver cirrhosis, Child-Turcotte-Pugh score B, with gross ascites. He presented with recurrent right sided pleural effusion. Pleural fluid analysis revealed transudative pleural effusion. A diagnosis of hepatic hydrothorax was made after excluding other causes of pleural effusion. He did not respond to medical therapy and sodium restriction. His recurrent pleural effusion was treated with tube thoracostomy and chemical talc pleurodesis. He was referred to the tertiary hepatology unit for transjugular intrahepatic portosystemic shunt (TIPSS) and liver transplantation. Hepatic hydrothorax should always be suspected in a patient who presents with liver cirrhosis with portal hypertension and transudative pleural effusion. http://pubs.sciepub.com/ajmcr/5/4/7/ajmcr-5-4-7.pdf hepatic hydrothorax cirrhosis thoracostomy transplantation portal hypertension