Massive pleural effusions in cirrhotic patients with ascites.

A method is described based on the passage of air across the diaphragm to detect pathological diaphragmatic orifices in autopsies. This method was used in 65 post-mortem studies; orifices were detected in 7 cases. Only one of these appears histologically to be a real spontaneous orifice. This was found in the post-mortem study of a cirrhotic patient with ascites and massive and recurrent hydrothorax. In eight patients with cirrhotic ascites and pleural effusions, radioisotopes were introduced into the ascites fluid, and only in two of them, both with right massive and recurrent pleural effusion, was radioactivity detected in the pleural cavity within the 1st h after injection. The radioisotopic method for detecting in vivo these orifices avoids the repeated taps that are necessary when dyes are used.