The morphology of diaphragmatic defects in hepatic hydrothorax: thoracoscopic finding.
BACKGROUND
Until now, the pathophysiology of hepatic hydrothorax has been moot. We discuss (on the basis of gross videothoracoscopy findings in 11 cases and the literature) the pathogenesis and clinical presentation of this complex condition.


METHODS
We prospectively studied 11 patients (age, 31-73 years; 6 men and 5 women) with refractory hepatic hydrothorax (Child-Pugh class B-C) who underwent thoracoscopic repair of diaphragmatic defects. The diaphragmatic defects were examined intraoperatively.


RESULTS
The diaphragmatic defects stemming from hepatic hydrothorax were classified into 4 morphologic types: type I, no obvious defect (1 patient); type II, blebs lying on the diaphragm (4 patients); type III, broken defects (fenestrations) in the diaphragm (8 patients); and type IV, multiple gaps in the diaphragm (1 patient). The type of diaphragmatic defect did not correlate with the volume occupied by the pleural effusion in the preoperative chest radiograms.


CONCLUSIONS
The finding of this study allowed hepatic hydrothorax pathophysiology to be directly visualized, and further studies concerning the treatment of hepatic hydrothorax might be based on these mechanisms.
Division of Thoracic Surgery, National Taiwan University College of Medicine, National Taiwan University Hospital, No. 7 Chung-Shan South Road, Taipei 100, Taiwan.
Pei-Ming
PM
Huang
Yih-Leong
YL
Chang
Ching-Yao
CY
Yang
Yung-Chie
YC
Lee
D000368:Aged; D003964:Diaphragm / Q000473:pathology*; D005260:Female; D006801:Humans; D006876:Hydrothorax / Q000150:complications / Q000473:pathology* / Q000503:physiopathology / Q000601:surgery; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013906:Thoracoscopy