Q: 52 year old male with end stage liver disease - presented with shortness of breath. Patient is found to have massive right sided hydrothorax. Which one procedure should be avoided?

Answer: Inserting chest tube

Chest tube should almost never be inserted in hydrothorax unless there is an evidence of pyothorax or pneumothorax. 

Treatment option to be considered in clinically significant hydrothorax is TIPS (though it may transiently worsened hepatic encephalopathy). The ultimate treatment is a liver transplant.