Tapped Twice: A Case of a Rapidly Re-accumulating Hepatic Hydrothorax in a Patient with Spontaneous Bacterial Empyema

Hepatic hydrothorax (HH) is a complication of decompensated liver cirrhosis that only occurs in about 5–6% patients, defined as pleural fluid the setting known disease, with absence any other cardiopulmonary etiology. Infected HH rare complication, designated spontaneous bacterial empyema (SBEM), found 13–16% patients HH. This case follows patient SBEM who developed recurrent effusion minutes after thoracentesis. Our 56-year-old female history alcoholic pleuritic pain to have right-sided decompensation. She had no ascites. was initiated on antibiotics due leukocytosis and underwent thoracentesis, revealing sterile but exudative high neutrophil count, confirming diagnosis SBEM. Despite initial symptom relief, her respiratory symptoms recurred within mere Imaging showed reaccumulated effusion, repeat thoracentesis transudative suggesting While she our care, we pursued expert consultation gastroenterology thoracic surgery; based shared clinical decision making, agreed definitive intervention either indwelling catheter or intrapleural surgical options would cause more harm than good given cirrhosis. The discharged instructions for serial close follow-up discuss next steps regarding advanced uncontrolled We refer this its SBEM, well management these conditions.