Scintigraphic demonstration of a diaphragmatic defect as the cause of massive hydrothorax in cirrhosis

Serena, Andrés; Aliaga, L; Richter, José A.; Calderon, Rossana M.; Sánchez-Lorenzo, Luisa; Charvet, M. A.

doi:10.1007/bf00440961

Cited by 17 publications

(10 citation statements)

References 13 publications

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“…This mechanism has been corroborated with nuclear medicine studies using [99Tcm]-human albumin or [99Tcm]-sulphur colloid and dye studies that show a unidirectional passage of these markers from the abdominal to the pleural cavity in the first 24 h after administration. [16][17][18] Other proposed mechanisms, which are mostly speculative, include an increase in azygous vein pressure and flow leading to leakage of plasma, 19 fluid traversing from the abdominal cavity to pleural space across transdiaphragmatic lymphatics, 20 hypoalbuminaemia with decreased colloid osmotic pressure 21 and leakage of the thoracic duct. 22 Although not specifically addressed in hepatic hydrothorax, the rate of reabsorption of ascites back into the intravascular compartment could also play an important role in the pathogenesis of hepatic hydrothorax.…”

Section: 12mentioning

confidence: 99%

Hepatic hydrothorax

Cárdenas

Kelleher

Chopra

2004

Aliment Pharmacol Ther

149

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SUMMARYPatients with cirrhosis and portal hypertension often have abnormal extracellular fluid volume regulation, resulting in accumulation of fluid as ascites, oedema or pleural effusion. These complications carry a poor prognosis with nearly half of the patients with ascites dying in the ensuing 2-3 years. In contrast to what happens in the abdominal cavity where large amounts of fluid (5-8 L) accumulate with the patient only experiencing only mild symptoms, in the thoracic cavity smaller amounts of fluid (1-2 L) cause severe symptoms such as shortness of breath, cough and hypoxaemia. Hepatic hydrothorax is defined as a pleural effusion, usually >500 mL, in patients with cirrhosis without cardiopulmonary disease. The pathophysiology involves the direct movement of ascitic fluid from the peritoneal cavity into the pleural space through diaphragmatic defects. The estimated prevalence among cirrhotic patients is 5-10%. The effusion, which is a transudate, most commonly occurs in the right hemithorax. The mainstay of therapy is similar to that of portal hypertensive ascites and includes sodium restriction and administration of diuretics. Refractory hydrothorax can be managed with transjugular intrahepatic portosystemic shunt in selected cases. Pleurodesis is not routinely recommended. Suitable patients with hepatic hydrothorax should be considered candidates for liver transplantation.

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Section: 12mentioning

confidence: 99%

Hepatic hydrothorax

Cárdenas

Kelleher

Chopra

2004

Aliment Pharmacol Ther

149

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“…These postural changes may not be clinically practical in critically ill patients. Another example is injecting radioisotope (such as 99m Tc-sulfur colloid) into the peritoneum and then visualizing the tracer in the hemithorax [13, 14]. …”

Section: Discussionmentioning

confidence: 99%

Nuclear Imaging to Detect Diaphragmatic Perforation as a Rare Complication of Microwave Ablation

Cull

Khneizer

Krishna

et al. 2017

Case Reports in Critical Care

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Acquired diaphragmatic perforation leading to massive hepatic hydrothorax and respiratory failure is a rare complication of microwave ablation (MWA) of hepatocellular carcinoma (HCC). Imaging modalities to detect pleuroperitoneal communication remain poorly described. We report a nuclear imaging technique used to efficiently diagnose and locate diaphragmatic defects. A 57-year-old male with cirrhosis and HCC presented with respiratory distress after undergoing MWA of a HCC lesion. He was admitted to the intensive care unit for noninvasive positive pressure ventilator support. Chest radiography revealed a new large right pleural effusion. Large-volume thoracentesis was consistent with hepatic hydrothorax. The fluid reaccumulated within 24 hours; therefore an acquired diaphragmatic perforation induced by the ablation procedure was suspected. To investigate, 99mTechnetium-labeled albumin was injected into the peritoneal cavity. The tracer accumulated in the right hemi thorax almost immediately. The patient then underwent transjugular intrahepatic portosystemic shunting in efforts to relieve portal hypertension and decrease ascites volume. Unfortunately, the patient deteriorated and expired after few days. Although diaphragmatic defects develop in cirrhotic patients, such small fenestrations do not normally lead to rapid development of life-threatening pleural effusion. MWA procedures can cause large diaphragmatic defects. Immediate detection of this complication is essential for initiating early intervention.

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“…These non-L."l.vasive methods will hep the sician to find out the origin of the thorax in order to establish the diagnosis and appropriate treatment (5,8,9,11,14).…”

Section: Discussionmentioning

confidence: 99%

HEPATIC HYDOTHORAX WITH AND WITHOUT ASCITES Scintigraphic Demonstration of Furıctional Unidirectional Diophragmatic Leaks

Osmanağaoğlu¹,

Çağa²,

Schelstraete³

et al. 1995

Tepecik Dergisi

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Ka:rel SCHELSTRAETJE Maris SHVIONS SUMMARYHydrothorax is not a very common symptom in patients with hepatic dnhosis, espedaHy when the:re is mı dinical evidence of concomitant asdtes. Befo:re accepHng the hepatic o:rigin of the hydrothorax it is necessary to exdude other cardiac, pulmonary or renal pathologies whkh could be parl:ly or enHrely responsi.ble for this symptom. ~fhe existence of asdtes may help to ımggest the origin of hyd.rothorax. In patients with hydrothorax without asdtes, es~ tablishing the diagnose is mo re complicated. W e present two hepatic cirrhotic patients with right hydothorax in the absence and presence of ascites using radioisotopic techniques it was demonstrated that in both situations the pleural fluid originated in the abdomen and hence was transporh~d into the pleural cavity. There was no fluid transfer in the opposite diredion.(Key Words: Asdtes, Cirrhosis, Hydrothorax, 99m-Technetium tin colloid.) ÖZET Karaciğer sirozlu hastalarda özellikle asit geli~memi~se hidrotoraks ender geli~ir. Hidrotoraksın karaciğer orijinli olduğunu kabul etmezden önce akciğer, kalb ve böbrek patolojileri elimine edilmelidir. Asitsiz hastalarda tam güçle~ir. 2 karaciğer sirozlu (biri asitsiz) ve sağ hidrotorakslı hastada radyoizotop tekniğiyle plevral sıvının karın orijinli olduğunu gös-terdik Kar~ı yönde sıvı transferi yoktu.

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Scintigraphic demonstration of a diaphragmatic defect as the cause of massive hydrothorax in cirrhosis

Cited by 17 publications

References 13 publications

Hepatic hydrothorax

Hepatic hydrothorax

Nuclear Imaging to Detect Diaphragmatic Perforation as a Rare Complication of Microwave Ablation

HEPATIC HYDOTHORAX WITH AND WITHOUT ASCITES Scintigraphic Demonstration of Furıctional Unidirectional Diophragmatic Leaks

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