Isotopic exploration of hepatic hydrothorax: ten cases

Ajmi, S.; Hassine, Habib; Guezguez, M.; Elajmi, Salem; Dali, K. Mrad; Karmani, M.; Zayane, Ahlem; Essabbah, H.

doi:10.1016/s0399-8320(04)94958-5

Cited by 23 publications

(15 citation statements)

References 28 publications

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“…Hepatic hydrothorax can be seen in the absence of ascites due to the negative intrathoracic pressure during breathing, drawing the peritoneal fluid through diaphragmatic defects into the pleural cavity. Radioisotopes 3,4 and indocyanine green 5 are useful for detecting the transdiaphragmatic passage of ascitic fluid into the pleural cavity. Direct demonstration of a diaphragmatic defect with non‐invasive imaging techniques, such as magnetic resonance imaging, is extremely difficult, as the defect itself is usually quite small 10 .…”

Section: Discussionmentioning

confidence: 99%

“…In most patients, such pleural effusion is due to the passage of ascitic fluid into the pleural cavity through defects in the tender portion of the diaphragm 2 . However, proposed procedures to detect movement of ascitic fluid into the pleura cavity are complicated and sometimes require harmful materials, such as radioisotopes and indocyanine green 3–5 . We previously reported left‐sided hepatic hydrothorax diagnosed by contrast‐enhanced ultrasonography with an intraperitoneal injection of Levovist (Schering, Berlin, Germany) 6 .…”

Section: Introductionmentioning

confidence: 99%

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Diagnosis of hepatic hydrothorax using contrast‐enhanced ultrasonography with intraperitoneal injection of Sonazoid

Tamano

Hashimoto

Kojima

et al. 2010

J of Gastro and Hepatol

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Background and Aim: We investigated the utility and safety of contrast-enhanced ultrasonography using Sonazoid in the diagnosis of hepatic hydrothorax. Methods: The study consisted of seven liver cirrhosis patients with hydrothorax and hydroperitoneum. After obtaining informed consent, Sonazoid was injected intraperitoneally, and enhancement in the peritoneal and pleural cavities was observed. Results: In all patients, the peritoneal cavity was quickly enhanced after the Sonazoid injection. The pleural cavity was enhanced in five of the seven patients, and these five patients were diagnosed with hepatic hydrothorax. Two patients without enhancement of the pleural cavity were diagnosed with inflammatory hydrothorax. Conclusions: This is the first report to confirm transdiaphragmatic movement of ascitic fluid into the pleural cavity using contrast-enhanced ultrasonography with Sonazoid. This method can safely detect ascitic flow in real time, and is thus very useful for the diagnosis of hepatic hydrothorax.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Diagnosis of hepatic hydrothorax using contrast‐enhanced ultrasonography with intraperitoneal injection of Sonazoid

Tamano

Hashimoto

Kojima

et al. 2010

J of Gastro and Hepatol

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“…The best test to confirm the communication between the pleural and the peritoneal space is scintigraphy which involves the intraperitoneal administration of a radioisotope and the migration of the radioisotope into the pleural cavity after few hours [41,42,43]. Transdiaphragmatic movement of ascitic fluid into the pleural cavity using contrast-enhanced ultrasonography with the contrast agent Sonazoid has also been reported [44].…”

Section: Diagnosismentioning

confidence: 99%

Evidence-Based Review of the Management of Hepatic Hydrothorax

Singh¹,

Bajwa²,

Shujaat³

2013

Respiration

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Hepatic hydrothorax (HH) is an example of a porous diaphragm syndrome. Portal hypertension results in the formation of ascitic fluid which moves across defects in the diaphragm and accumulates in the pleural space. Consequently, the treatment approach to HH consists of measures to reduce the formation of ascitic fluid, prevent the movement of ascitic fluid across the diaphragm, and drain or obliterate the pleural space. Approximately 21-26% of cases of HH are refractory to salt and fluid restriction and diuretics and warrant consideration of additional treatment measures. Ideally, liver transplantation is the best treatment option; however, most of the patients are not candidates and most of those who are eligible die while waiting for a transplant. Treatment measures other than liver transplantation may not only provide relief from dyspnea but also improve patient survival and serve as a bridge to liver transplantation.

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“…The diagnosis is a clinical diagnosis, typically made in patients with cirrhosis, portal hypertension, ascites, and a transudative pleural effusion. Although uncommon, HHT can occur even in patients with minimal or no apparent ascites, perhaps attributed to intra‐abdominal pressure greater than pleural pressure, creating a caudal gradient . However, a lack of ascites can make the diagnosis challenging.…”

mentioning

confidence: 99%

“…Although uncommon, HHT can occur even in patients with minimal or no apparent ascites, perhaps attributed to intra-abdominal pressure greater than pleural pressure, creating a caudal gradient. (2) However, a lack of ascites can make the diagnosis challenging. An excellent diagnostic approach is to confirm the diagnosis by use of peritoneal scintigraphy, but is exceptionally challenging in patients without ascites.…”

mentioning

confidence: 99%