Q: 42 year old male with well known history of cirrhosis is admitted with shortness of breath. Clinical exam showed ascites and CXR showed hydrothorax. Paracentesis is performed in ER with some relief. Chest tube is planned by ER resident. Why it would be a bad idea to insert - particularly a large bore chest tube in a patient with hydrothorax?



Answer: Insertion of chest tube in hydrothorax is a bad idea as it usually results in uncontrollable fluid loss and has a high mortality secondary to hypovolemic shock. Therapeutic thoracocentesis with albumin replacement may provide temporary relief but may refill again. Thoracocentesis combined with pleurodesy, LeVeen or Denver shunt or surgical repair are other options. Management of underlying cause is warranted like placement of TIPS.