use radioisotope scan to diagnose hepatic hydrothorax
- related: pleural effusion
- tags: #literature #boards
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Hepatic hydrothorax occurs when ascites passes through defects in the diaphragm into the pleural space. These defects are more common on the right but can also occur on the left. Persistent reaccumulation of pleural effusion despite sodium restriction and diuretic therapy is consistent with hepatic hydrothorax. Although chylothorax has been reported, effusions are typically transudates in nature. An echocardiogram will often show normal systolic function, and in some cases with portopulmonary hypertension, right-sided pressures may be elevated. The echocardiogram will exclude pleural fluid related to heart dysfunction, but it will not confirm diagnosis of hepatic hydothorax. Definitive diagnosis with injection of intraperitoneal 99-mTc sulphur colloid or 99mTc-human serum albumin can be helpful. The radioisotopes migrate from the peritoneal cavity into the pleural space, thereby confirming communication between the two spaces and the hepatic hydrothorax.1