Purpose of Review <p>Hepatic hydrothorax (HH) is a transudative pleural effusion occurring in patients with cirrhosis and portal hypertension. This review aims to provide a contemporary, pleural physician–centred overview of HH management, addressing diagnostic challenges and therapeutic options beyond traditional hepatology-led care.</p> Recent Findings <p>While sodium restriction, diuretics, TIPS, and transplantation remain mainstays, pleural-directed strategies such as therapeutic thoracentesis, indwelling pleural catheters (IPCs), and pleurodesis are increasingly important, particularly in non-transplant candidates. Emerging data support the cautious use of IPCs and pleurodesis, and thoracoscopic diaphragmatic repair may be appropriate in selected cases. Multidisciplinary coordination is essential for patient selection and treatment planning.</p> Summary <p>Pleural physicians now play a central role in the care of HH, from diagnosis to intervention. A practical management algorithm is proposed, and future research should focus on defining the comparative effectiveness and safety of pleural therapies. Integration with hepatology and transplant services remains crucial for improving outcomes.</p>