Gastroenterology Research, ISSN 1918-2805 print, 1918-2813 online, Open Access
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Case Report

Volume 2, Number 4, August 2009, pages 248-252

Diffrential Diagnosis of Hepatic Hydrothorax by 99mTc Sulfur Colloid Peritoneal Scintigraphy: Two Cases

Figures

Figure 1.
Figure 1. PA chest radiograph of the case 1: a large pleural effusion was seen in the right hemithorax.
Figure 2.
Figure 2. Peritoneal scintigraphy of the case 1 at 3 h: at 10 min, the tracer was diffused in the abdominal region, which confirmed that it was injected properly in the peritoneal cavity; at 3 h, the tracer was seen in the right side of the thoracic region (i.e. pleural space) (arrows). This image suggested peritoneo-pleural communication and hepatic hydrothorax.
Figure 3.
Figure 3. Post-treatment PA chest radiograph of the case 1: no evidence of pleural effusion was seen.
Figure 4.
Figure 4. Pre-treatment PA chest radiograph of the case 2: a large pleural effusion evident in the left hemithorax was seen.
Figure 5.
Figure 5. Peritoneal scintigraphy of the case 2 at 24 h: at 10 min, the tracer was diffused in the abdominal region, which confirmed that it was injected in the peritoneal cavity; at 6 h and 24 h, the tracer was seen in the region of abdominal cavity, but not in the thoracic region. This image suggested no peritoneo-pleural communication in the case 2.
Figure 6.
Figure 6. Post-treatment PA chest radiograph of the case 2: no evidence of pleural effusion was seen.

Table

Table 1. Laboratory results of patients
 
Case 1Case 2
WBC: White blood cell; Hb: Hemoglobin; ESR: Eryhtrocyte sedimentation rate; SAAG: Serum ascites albumin gradient; SPAG: Serum pleural effusion albumin gradient; INR: International normalized ratio; ADA: Adenosine deaminase activity.
Age4453
SexMaleMale
Side of effusionRightLeft
WBC153003800
Hb15.712.9
ESR3590
Serum albumin2.93.1
SAAG1.50.8
SPAG1.10.4
INR1.71.1
Leukocytes in ascites-507
Lymphocytes in ascites-190
ADA level in ascites10165