DETECTION OF DIAPHRAGMATIC DEFECT AS THE CAUSE OF SEVERE HEPATIC HYDROTHORAX WITH MAGNETIC-RESONANCE-IMAGING

Severe right-sided hepatic hydrothorax occurred in an 83-yr-old Japane se woman with a 7-yr history of cryptogenic liver cirrhosis, Transdiap hragmatic communication was indirectly suggested by rapid migration of dye (indocyanine green) from the peritoneal to the pleural space, Mag netic resonance imaging studies also demonstrated a diaphragmatic defe ct as a characteristic hypointense jet flow across the diaphragm on bo th T1- and T2-weighted sagittal scans. Although no firm treatment for hepatic hydrothorax has been established and direct demonstration of d iaphragmatic defect with noninvasive imaging is extremely rare, testin g for diaphragmatic integrity is meaningful to provide a radical or le ss invasive treatment. Magnetic resonance imaging, as well as color Do ppler ultrasonography, may be useful for the detection of diaphragmati c defects as the cause of hepatic hydrothorax. (C) 1998 by Am, Cell. o f Gastroenterology.