HEPATIC HYDROTHORAX - POSSIBLE ETIOLOGY OF RECURRING PLEURAL EFFUSION

A case of hepatic hydrothorax is presented as a reminder that a large, recurring pleural effusion may have an abdominal source, even in pati ents with minimal or no apparent ascites. One of the known mechanisms for hepatic hydrothorax is a peritoneopleural communication, as demons trated in this case. A simple radionuclide imaging procedure, in which technetium 99m-sulfur colloid is injected into the peritoneal cavity prior to imaging of the chest and abdomen, can be used to document thi s finding. Treatment may include therapeutic thoracentesis, salt and w ater restriction, diuretics, tube thoracostomy with pleurodesis, surgi cal repair or placement of a portosystemic shunt.