Author |
이재태(Jae Tae Lee),이규보(Kyu Bo Lee),황기석(Kee Suk Whang),김광원(Gwang Weon Kim),정병천(Byung Cheon Chung),조동규(Dong Kyu Cho),정준모(Joon Mo Chung), |
Abstract |
Simultaneous presence of ascites and pleural effusion
has been documented in patients with cirrhosisof the
liver, renal disease, Meigs' syndrome and in patients
undergoing peritoneal dialysis. Mechanisms proposed in
the formation of pleural effusion in most of the above
diseases are lymphatic drainage and diaphragmatic
defect. But sometimes, hepatic hydrothoraxes in the
absence of clinical ascites and pleural effusion
secondary to pulmonary or cardiac disease are noted. It
is not always possible to differentiate between pleural
effusion caused by transdiaphragmatic migration of
ascites and by other causes based soly on biochemical
analysis. Authors performed radionuclide scintigraphy
after intraperitoneal administration of Tc-99m-labeled
colloid in 23 patients with both ascites and pleural
effusion in order to discriminate causative mechanisms
responsible for pleural effusion. Scintigraphy
demonstrated the transdiaphtagmatic flow of fluid from
the peritoneum to pleural cavities in 13 patients
correctly. In contrast, in 5 patients with pleural
effusion secondary to pulmonary, pleural and cardiac
diseases, radiotracers fail to traverse the diaphragm
and localize in the pleural space. Ascites draining to
mediastinal lymph nodes and blocked passage of
lymphatic drainage were also clarified, additionaly.
Conclusively, radionuclide peritoneal scintigraphy is
an accurate, rapid and easy diagnostic tool in patients
with both ascites and pleural effusion. It enables the
causes of pleural effusion to be elucidated, as well as
providing valuable information required when
determining the appropriate therapy. |