摘要

Two cases of right hepatic hydrothorax occurring in the absence of clinical ascites are reported. Diagnosis was confirmed by the intraperitoneal and intrapleural injection of radioisotope 99mTc-sulfur colloid that demonstrated the one-way transdiaphragmatic flow of fluid from the peritoneal to pleural cavities. In contrast, radioisotope injected into the peritoneal cavity of 5 patients with pleural effusions secondary to pulmonary or cardiac disease failed to traverse the diaphragm and localize in the pleural space. Medical therapy with salt and water restriction and diuretics resulted in both of the patients with hepatic hydrothorax developing signs of intravascular volume depletion without significant mobilization of the pleural fluid. Thoracotomy allowed identification of the diaphragmatic defects that were repaired by chemical and traumatic pleurodesis followed by postoperative peritoneal and pleural drainage. This therapy resulted in complete resolution of the pleural effusions, which have not recurred despite the subsequent development of clinical ascites in both patients.

译文

报告了两例右肝性胸水发生在没有临床腹水的情况下。通过腹腔和胸腔内注射放射性同位素 99mtc-硫胶体证实了诊断，表明了液体从腹膜到胸膜腔的单向跨膈肌流动。相比之下，5 名继发于肺部或心脏疾病的胸水患者腹腔注射的放射性同位素未能穿过隔膜并定位于胸膜间隙。限制盐和水的药物治疗和利尿剂导致两个肝性胸水患者出现血管内容量耗尽的迹象，而没有明显调动胸水。开胸手术可以识别经化学和创伤性胸膜固定修复的膈肌缺损，然后进行术后腹腔和胸腔引流。这种疗法导致胸水完全消退，尽管两名患者随后都出现了临床腹水，但胸水并未复发。