Pleural Effusion from Leaky Diaphragm—the Hepatic Hydrothorax

Excerpt

A 76-year-old woman with liver cirrhosis presented with six weeks of progressive shortness of breath, and was found to have a large right pleural effusion with minimal ascites. Echocardiogram showed normal left ventricular ejection fraction. The portal venous system was patent by Doppler ultrasound. Pleural fluid analysis revealed a transudative effusion without evidence of infection or malignancy. Despite drainage and diuretics, her effusion recurred. When technetium was injected into the peritoneal cavity for nuclear imaging, there was strong uptake in the perihepatic fluid collection and diffuse uptake into the right hemithorax, suggesting a peritoneo-pleural communication, confirming the diagnosis of hepatic hydrothorax (Figs. 1 and 2). The patient underwent a transjugular intrahepatic portosystemic shunt (TIPS) procedure with improvement of symptoms.

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