1
|
Sharma R, Meyer CA, Frazier AA, Martin Rother MD, Kusmirek JE, Kanne JP. Routes of Transdiaphragmatic Migration from the Abdomen to the Chest. Radiographics 2020; 40:1205-1218. [PMID: 32706612 DOI: 10.1148/rg.2020200026] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
The diaphragm serves as an anatomic border between the abdominal and thoracic cavities. Pathologic conditions traversing the diaphragm are often incompletely described and may be overlooked, resulting in diagnostic delays. Several routes allow abdominal contents or pathologic processes to spread into the thorax, including along normal transphrenic structures, through congenital defects in the diaphragm, through inherent areas of weakness between muscle groups, or by pathways created by tissue destruction, trauma, or iatrogenic injuries. A thorough knowledge of the anatomy of the diaphragm can inform an accurate differential diagnosis. Often, intraperitoneal pathologic conditions crossing the diaphragm may be overlooked if axial imaging is the only approach to this complex region because of the horizontal orientation of much of the diaphragm. Multiplanar capabilities of volumetric CT and MRI provide insight into the pathways where pathologic conditions may traverse this border. Knowledge of these characteristic routes and use of multiplanar imaging are critical for depiction of specific transdiaphragmatic pathologic conditions.©RSNA, 2020.
Collapse
Affiliation(s)
- Ruchi Sharma
- From the Department of Radiology, Section of Thoracic Imaging, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (R.S., C.A.M., M.D.M.R., J.E.K., J.P.K.); and Division of Cardiothoracic Imaging, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md, and Cardiothoracic Section, American Institute for Radiologic Pathology, Silver Spring, Md (A.A.F.)
| | - Cristopher A Meyer
- From the Department of Radiology, Section of Thoracic Imaging, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (R.S., C.A.M., M.D.M.R., J.E.K., J.P.K.); and Division of Cardiothoracic Imaging, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md, and Cardiothoracic Section, American Institute for Radiologic Pathology, Silver Spring, Md (A.A.F.)
| | - Aletta A Frazier
- From the Department of Radiology, Section of Thoracic Imaging, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (R.S., C.A.M., M.D.M.R., J.E.K., J.P.K.); and Division of Cardiothoracic Imaging, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md, and Cardiothoracic Section, American Institute for Radiologic Pathology, Silver Spring, Md (A.A.F.)
| | - Maria D Martin Rother
- From the Department of Radiology, Section of Thoracic Imaging, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (R.S., C.A.M., M.D.M.R., J.E.K., J.P.K.); and Division of Cardiothoracic Imaging, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md, and Cardiothoracic Section, American Institute for Radiologic Pathology, Silver Spring, Md (A.A.F.)
| | - Joanna E Kusmirek
- From the Department of Radiology, Section of Thoracic Imaging, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (R.S., C.A.M., M.D.M.R., J.E.K., J.P.K.); and Division of Cardiothoracic Imaging, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md, and Cardiothoracic Section, American Institute for Radiologic Pathology, Silver Spring, Md (A.A.F.)
| | - Jeffrey P Kanne
- From the Department of Radiology, Section of Thoracic Imaging, University of Wisconsin School of Medicine and Public Health, 600 Highland Ave, Madison, WI 53792 (R.S., C.A.M., M.D.M.R., J.E.K., J.P.K.); and Division of Cardiothoracic Imaging, Department of Radiology and Nuclear Medicine, University of Maryland School of Medicine, Baltimore, Md, and Cardiothoracic Section, American Institute for Radiologic Pathology, Silver Spring, Md (A.A.F.)
| |
Collapse
|
2
|
Abstract
Hepatic hydrothorax (HH) is a pleural effusion that develops in a patient with cirrhosis and portal hypertension in the absence of cardiopulmonary disease. Although the development of HH remains incompletely understood, the most acceptable explanation is that the pleural effusion is a result of a direct passage of ascitic fluid into the pleural cavity through a defect in the diaphragm due to the raised abdominal pressure and the negative pressure within the pleural space. Patients with HH can be asymptomatic or present with pulmonary symptoms such as shortness of breath, cough, hypoxemia, or respiratory failure associated with large pleural effusions. The diagnosis is established clinically by finding a serous transudate after exclusion of cardiopulmonary disease and is confirmed by radionuclide imaging demonstrating communication between the peritoneal and pleural spaces when necessary. Spontaneous bacterial empyema is serious complication of HH, which manifest by increased pleural fluid neutrophils or a positive bacterial culture and will require antibiotic therapy. The mainstay of therapy of HH is sodium restriction and administration of diuretics. When medical therapy fails, the only definitive treatment is liver transplantation. Therapeutic thoracentesis, indwelling tunneled pleural catheters, transjugular intrahepatic portosystemic shunt and thoracoscopic repair of diaphragmatic defects with pleural sclerosis can provide symptomatic relief, but the morbidity and mortality is high in these extremely ill patients.
Collapse
Affiliation(s)
- Yong Lv
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, China
| | - Guohong Han
- Department of Liver Diseases and Digestive Interventional Radiology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, China
| | - Daiming Fan
- State Key Laboratory of Cancer Biology, National Clinical Research Center for Digestive Diseases and Xijing Hospital of Digestive Diseases, Fourth Military Medical University, Xi'an 710032, China
| |
Collapse
|
5
|
Boin IF, Silva AM, Leonardi LS. Chemical pleurodesis for hepatic hydrothorax. ARQUIVOS DE GASTROENTEROLOGIA 2001; 38:125-8. [PMID: 11797649 DOI: 10.1590/s0004-28032001000200008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
BACKGROUND Ascites can occur after hepatic diseases causing dyspnea, coughing and pain. When associated with pleural effusion it can also increase respiratory distress. In a bibliographic survey hydrothorax has been observed in up to 20% of the patients and the kind of treatment is still being discussed. OBJECTIVE This case report shows the occurrence of a large volume of ascites and pleural effusion in a cirrhotic patient and his treatment. METHODS Report the case of a patient with hepatic cirrhosis due to chronic alcoholism and massive pleural effusion and ascites. He was submitted to several pleural paracenteses without success. Scintigraphy showed the presence of ascites and confirmed a possible pleuroperitoneal communication. The thoracic surgery group was called and after evaluation it was decided to submit the patient to a pulmonary decortication and chemical pleurodesis. RESULTS These procedures were carried out with success. The pleural effusion was solved and the treatment of ascites was decided upon because the patient did not accept any surgical procedure. CONCLUSION This treatment could be applied to patients with hydrothorax who could not be submitted to a liver transplantation.
Collapse
Affiliation(s)
- I F Boin
- Department of Surgery, Faculty of Medical Sciences, State University of Campinas (UNICAMP), Campinas, SP, Brazil.
| | | | | |
Collapse
|
6
|
Yaguchi T, Harada A, Sakakibara T, Komatsu Y, Yoshida S, Yokoi K, Murakami H, Fukuhara Y. A successful surgical repair of the hepatic hydrothorax using pneumoperitoneum: report of a case. Surg Today 1999; 29:795-8. [PMID: 10483761 DOI: 10.1007/bf02482331] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
A successful surgical repair of a right hepatic hydrothorax in the absence of ascites is reported. A technetium-99m scintigram that was injected intraperitoneally provided evidence of a one-way flow of fluid from the peritoneal to pleural cavity. To identify any possible minute defects in the diaphragm, carbon dioxide was insufflated into the peritoneal cavity during the operation. We performed a direct suture of the defect observed on the diaphragm. The pleural effusion subsequently vanished after the operation.
Collapse
Affiliation(s)
- T Yaguchi
- Department of Surgery, Aichi-ken Kousei-ren Kainan Hospital, Ama-gun, Aichi, Japan
| | | | | | | | | | | | | | | |
Collapse
|