{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,29]],"date-time":"2025-08-29T10:05:57Z","timestamp":1756461957106,"version":"3.44.0"},"reference-count":18,"publisher":"BMJ","issue":"11","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2019,10,16]]},"published-print":{"date-parts":[[2019,11]]},"abstract":"<jats:p>Pleural effusion in liver cirrhotics is more commonly transudative. A transudative pleural effusion secondary to ascites in decompensated cirrhosis is also known as hepatic hydrothorax and is usually due to fluid seepage through congenital pores in the diaphragm. The patient, a known case of decompensated chronic liver disease, presented with a massive, left-sided, rapidly accumulating and transudative pleural effusion secondary to spontaneous diaphragmatic rupture. Clinically, he developed sudden onset shortness of breath and became hypotensive. This is a rare entity, and was confirmed on CT thorax revealing a focal segment defect ~1.6\u2009cm over the left hemidiaphragm. Ascites treatment consisting of diuretics with salt restriction and repeated thoracentesis with albumin replacement improved his symptoms and lead to a complete resolution of the effusion.<\/jats:p>","DOI":"10.1136\/bcr-2019-231604","type":"journal-article","created":{"date-parts":[[2019,11,2]],"date-time":"2019-11-02T10:06:10Z","timestamp":1572689170000},"page":"e231604","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":4,"title":["Acute tension hydrothorax in chronic liver disease secondary to spontaneous diaphragmatic rupture"],"prefix":"10.1136","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6476-1832","authenticated-orcid":false,"given":"Kevin Joseph","family":"Tharappel","sequence":"first","affiliation":[{"name":"Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nandakrishna","family":"Bolanthakodi","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sudha","family":"Vidyasagar","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muralidhar","family":"Varma","sequence":"additional","affiliation":[{"name":"Department of Medicine, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, India"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,11,2]]},"reference":[{"key":"2025082710281984000_12.11.e231604.1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-61-3-385"},{"key":"2025082710281984000_12.11.e231604.2","first-page":"579","article-title":"Risk factors for spontaneous bacterial empyema in cirrhotic patients with hydrothorax","volume":"66","author":"Chen","year":"2003","journal-title":"J Chin Med Assoc"},{"key":"2025082710281984000_12.11.e231604.3","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-64-2-341"},{"key":"2025082710281984000_12.11.e231604.4","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM196009082631001"},{"key":"2025082710281984000_12.11.e231604.5","first-page":"263","article-title":"Witts LJ: ascites in chronic disease of the liver","volume":"16","author":"Higgins","year":"1947","journal-title":"QJ Med"},{"key":"2025082710281984000_12.11.e231604.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2004.08.051"},{"key":"2025082710281984000_12.11.e231604.7","unstructured":"Castellote J , Xiol X . 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