Real-time contrast-enhanced ultrasound--a new simple tool for detection of peritoneal-pleural communications in hepatic hydrothorax.
OBJECTIVE
Hepatic hydrothorax is defined as the accumulation of pleural effusion in a cirrhotic patient in the absence of pulmonary or cardiac disease. Peritoneal fluid can pass into the pleural space through diaphragmatic fenestrations. The demonstration of such passage is important to establish the diagnosis of hepatic hydrothorax and can be achieved by intraperitoneal injection of nuclear contrast agents. Our aim was to evaluate the ability of contrast enhanced ultrasound in the detection of peritoneal-pleural communications.


METHODS
Seven patients with cirrhotic ascites and pleural effusion were studied in order to make a diagnosis of hepatic hydrothorax. SonoVue was injected into the peritoneal cavity (9.8 mL), and the peritoneal and pleural cavities were monitored by ultrasound. All patients were then studied using a nuclear scan.


RESULTS
Passage of SonoVue from the peritoneal to the pleural cavities was seen in 5 patients. In 2 patients, no passage of contrast agent was detectable. Nuclear scan was consistent with contrast enhanced ultrasound in all patients.


CONCLUSIONS
This study shows that the presence of peritoneal-pleural communications can be demonstrated by real time contrast enhanced ultrasound, whose results are comparable to those of nuclear scan. Contrast enhanced ultrasound is cheaper and could theoretically be performed wherever ultrasound facilities are available.
Foschi
F G
FG
Department of Internal Medicine, Faenza Hospital, Faenza, RA. fg.foschi@ausl.ra.it
Piscaglia
F
F
Pompili
M
M
Corbelli
C
C
Marano
G
G
Righini
R
R
Alvisi
V
V
Gasbarrini
G
G
Bolondi
L
L
Bernardi
M
M
Stefanini
G F
GF
D000368:Aged; D000437:Alcoholism / Q000150:complications; D003287:Contrast Media; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D006876:Hydrothorax / Q000000981:diagnostic imaging*; D007089:Image Enhancement; D008107:Liver Diseases / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010529:Peritoneal Cavity / Q000000981:diagnostic imaging*; D010994:Pleura / Q000000981:diagnostic imaging*; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000378:metabolism; D011877:Radionuclide Imaging; D014463:Ultrasonography
D003287:Contrast Media