Scintigraphic evaluation of hepatic hydrothorax

Hepatik hidrotoraks, primer kardiyak veya pulmoner hastalık olmaksızın sirozlu bir hastada önemli miktarda (genellikle 500 ml’den fazla) plöral sıvı birikmesidir. Hepatik hidrotoraks, sirozlu hastaların %4-%10’unu etkiler. Plöral efüzyon genellikle sağda olmakla birlikte solda veya bilateral olabilir. Asit sıvısının diafragmadaki defektler veya lenfatikler yoluyla geçişi, plöral alanda sıvı birikimine neden olabilir. Plöral efüzyonu olan sirozlu bir hastada göğüs bölgesinin görüntülemesi ve diagnostik torasentez yapılmalıdır. Peritoneal ve plöral boşluklar arasındaki geçişin gösterilmesi, boyalar, hava ve radyonüklitlerin intraperitoneal enjeksiyonu ile yapılabilir. İnvaziv olmayan peritoneal sintigrafi, kolaylığı ve yüksek tanısal duyarlığı nedeniyle tercih edilmelidir. Burada, peritoneaoplöral geçişi peritoneal sintigrafi ile değerlendirilen, sirozu ve plöral efüzyonu olan bir hastayı sunuyoruz.

Hepatik hidrotoraksta sintigrafik değerlendirme

Hepatic hydrothorax is defined as the accumulation of significant pleural effusion (usually>500 ml) in a cirrhotic patient without primary pulmonary or cardiac disease. Hepatic hydrothorax affects 4%-10% of patients with cirrhosis. The pleural effusion is usually right sided, but may be bilateral or left sided. Direct migration of ascitic fluid via a diaphragmatic defect or lymphatic channels can cause leakage of fluid into the pleural space. Imaging of the chest and diagnostic thoracentesis should be performed in patients with cirrhosis and pleural effusion. Demonstration of communication between the peritoneal and pleural space can be made by intraperitoneal injection of air, dyes and radionuclides. Noninvasive peritoneal scintigraphy should be preferred for its simplicity and high diagnostic sensitivity. Here, we present a case with cirrhosis and pleural effusion which had been evaluated by peritoneal scintigraphy for the evaluation of peritoneopleural communication.

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