Department of Internal Medicine 1, Hospital of the Goethe University Frankfurt, Frankfurt am Main, Germany.
Department of Gastroenterology, Krankenhaus Agatharied, Hausham, Germany.
Ultraschall Med. 2022 Oct;43(5):473-478. doi: 10.1055/a-1189-2937. Epub 2020 Jul 16.
Hepatic hydrothorax (HH) is defined as transudate in the pleural cavity in patients with decompensated liver cirrhosis (DC) without concomitant cardiopulmonary or pleural disease. It is associated with high short-term mortality. HH can evolve via translocation through diaphragmatic gaps. The aim of this study was to evaluate the feasibility and safety of injecting ultrasound contrast medium into the peritoneal cavity to detect HH.
This study included patients with concomitant ascites and pleural effusion who were admitted to our hospital between March 2009 and February 2019. A peritoneal catheter was inserted and ultrasound contrast medium was injected into the peritoneal cavity. In parallel, the peritoneal and pleural cavities were monitored for up to 10 minutes.
Overall, 43 patients were included. The median age was 60 years and the majority of patients were male (n = 32, 74 %). Most patients presented with right-sided pleural effusion (n = 32, 74 %), 3 (7 %) patients with left-sided and 8 (19 %) patients had bilateral pleural effusion. In 12 (28 %) patients ascites puncture was not safe due to low volume ascites. Thus, the procedure could be performed in 31 (72 %) patients. No adverse events occurred. In 16 of 31 (52 %) patients we could visualize a trans-diaphragmic flow of microbubbles. The median time until transition was 120 seconds.
Our clinical real-world experience supports the safety and feasibility of intraperitoneal ultrasound contrast medium application to detect HH in patients with DC, as a non-radioactive real-time visualization of HH. Our study comprises the largest cohort and longest experience using this method to date.
肝性胸水（HH）定义为失代偿性肝硬化（DC）患者胸腔中的漏出液，无伴发心肺或胸膜疾病。它与高短期死亡率相关。HH 可通过穿过横膈膜裂隙转移而发展。本研究旨在评估将超声造影剂注入腹腔以检测 HH 的可行性和安全性。
本研究纳入了 2009 年 3 月至 2019 年 2 月期间我院收治的同时伴有腹水和胸腔积液的患者。插入腹腔导管并向腹腔内注入超声造影剂，同时监测腹膜和胸腔腔长达 10 分钟。
共有 43 例患者入组。中位年龄为 60 岁，大多数患者为男性（n = 32，74 %）。大多数患者存在右侧胸腔积液（n = 32，74 %），3 例（7 例）患者存在左侧胸腔积液，8 例（19 例）患者存在双侧胸腔积液。由于腹水体积较少，12 例（28 例）患者的腹水穿刺术不安全。因此，31 例（72 例）患者可进行该操作。未发生不良事件。在 31 例患者中的 16 例中，我们可以观察到微泡穿过横膈膜的流动。转移的中位时间为 120 秒。
我们的临床真实世界经验支持在 DC 患者中应用腹腔内超声造影剂检测 HH 的安全性和可行性，作为 HH 的一种非放射性实时可视化方法。我们的研究是迄今为止使用该方法的最大队列和最长经验。
