Two patients with known chronic ascites developed new massive right-sided pleural effusions. Chest tube placement led to massive protein and electrolyte depletion and death of both patients. Patients who have cirrhosis and massive right-sided pleural effusions, in general, have congenital diaphragmatic defects that predispose them to life-threatening fluid depletion when chest tubes are inserted. Hepatic hydrothorax is a relative contraindication to chest tube insertion.