Amemiya T, Nishi K, Ohmori T, Ohka T, Myou S, Fujimura M, Matsuda T
Division of Pulmonary Medicine, Ishikawa Prefectural Central Hospital, Kanazawa, Japan.
Nihon Kyobu Shikkan Gakkai Zasshi. 1994 Aug;32(8):796-802.
A 80-year-old man was admitted to our hospital complaining of appetite loss, dry cough, and dyspnea on exertion. Chest X-ray film showed massive right pleural effusion. On physical examination, the right thorax was dull to percussion, and breath sounds of the right lung field were diminished. Examination of the cardiovascular system was unremarkable. Hepatosplenomegaly and ascites were not evident. The character of the pleural fluid was transudative. Cytological findings were negative and culture of the pleural fluid was normal. First, the pleural fluid was diminished by thoracic drainage. But, after the cessation of drainage, the pleural fluid soon reaccumulated. Abdominal ultrasonography showed typical liver cirrhosis pattern without ascites. An intraperitoneal injection of 99mTc-sulfur colloid was followed by positive uptake of radioactivity in the right pleural cavity from 1 hour after the injection, demonstrating the existence of a direct perito-pleural communication. Thus, the diagnosis of liver cirrhosis presenting with right pleural fluid, without ascites was made. This case indicates that the absence of ascites cannot exclude cirrhosis as the etiologic cause of pleural effusion.
一名80岁男性因食欲减退、干咳和劳力性呼吸困难入院。胸部X线片显示右侧大量胸腔积液。体格检查时，右侧胸部叩诊呈浊音，右肺野呼吸音减弱。心血管系统检查无异常。肝脾肿大和腹水不明显。胸水性质为漏出液。细胞学检查结果为阴性，胸水培养正常。首先，通过胸腔引流使胸水减少。但是，引流停止后，胸水很快又重新积聚。腹部超声显示典型的肝硬化表现但无腹水。腹腔注射99mTc-硫胶体后，注射后1小时起右侧胸腔即出现放射性阳性摄取，表明存在直接的腹膜-胸膜通道。因此，诊断为肝硬化伴右侧胸水且无腹水。该病例表明，无腹水并不能排除肝硬化作为胸腔积液的病因。
