Indwelling pleural catheters (IPCs) are recommended as one of the first-line treatment options for malignant pleural effusions (MPEs). It was not until recently that IPCs received US Food and Drug Administration (FDA) approval for the management of non-MPEs refractory to medical treatment. The role of IPCs in the management of hepatic hydrothorax (HH) is of considerable interest, as treatment options are limited and management can be challenging. HH arises in 5% to 15% of patients who develop portal hypertension due to cirrhosis and is associated with increased morbidity and mortality. Refractory HH (HH that has partial or no response to medical therapy) occurs in up to 25% of patients and liver transplant is the definitive treatment. Patients who are not transplant candidates or have longer than 3 months wait time should be evaluated for transjugular intrahepatic porto-systemic shunt (TIPS). However, many patients are not TIPS candidates, and only 50% of those who undergo TIPS placement experience full response to the procedure. In addition, TIPS complications such as hepatic encephalop-athy, and stent thrombosis or stenosis are not uncommon. Serial thor-acentesis is effective for symptom management.
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