Isotopic exploration of hepatic hydrothorax: ten cases.
OBJECTIVE
The aim of this retrospective study was to evaluate the performance of peritoneal scintigraphy for the diagnosis of peritoneopleural communication in patients with cirrhosis and to discuss its role in therapeutic management.


METHODS
Ten patients with cirrhosis and pleural effusion were included in this study. Cirrhosis was due to viral hepatitis in eight patients, auto-immune disease in one patient and of unknown origin in one. The pleural effusion was right-sided in nine patients and bilateral in one. 99m-technetium sulfur colloid peritoneal scintigraphy was performed in all patients.


RESULTS
Scintigraphy revealed peritoneopleural communication in nine patients. In four patients, radioactivity appeared in the pleural cavity within a few minutes after injection of the radiotracer. In three of them, a large diaphragmatic defect was demonstrated by ultrasonography, magnetic resonance imaging or thoracoscopy. Complete response to medical treatment was observed in four patients. Scintigraphy revealed rapid radioactivity migration in four patients; diuretic treatment led to resolution of the hydrothorax in one of them. Three patients whose hydrothorax was refractory to medical treatment were treated by pleurodesis with talc. Resolution of the hydrothorax was achieved in one of them.


CONCLUSIONS
Peritoneal scintigraphy is a simple non-invasive method enabling confirmation of peritoneopleural communication in cirrhotic patients. The importance of the diaphragmatic defect can also be evaluated, providing a significant contribution to therapeutic decision-making.
Ajmi
Sami
S
Service de Médecine Nucléaire, Hôpital Sahloul, Sousse 4054 Tunisia.
Hassine
Habib
H
Guezguez
Mohsen
M
Elajmi
Salem
S
Mrad Dali
Kaouthar
K
Karmani
Monia
M
Zayane
Ahlem
A
Essabbah
Habib
H
D000328:Adult; D005260:Female; D006801:Humans; D006876:Hydrothorax / Q000000981:diagnostic imaging* / Q000209:etiology*; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D012189:Retrospective Studies