Color Doppler ultrasonography in detecting transdiaphragmatic flow of hepatic hydrothorax: Correlation with thoracoscopic findings

Many mechanisms have been proposed for hepatic hydrothorax (HH), pleural effusion seen in cirrhotic patients, and the transdiaphragmatic flow of ascitic fluid through the diaphragmatic defects is considered the most probable. There are several methods for diagnosis of HH, including biochemical analysis of ascitic and pleural fluids, conventional radiography, radioisotopic imaging, magnetic resonance imaging, and thoracoscopy. Among these, ultrasonography may be considered the easiest method and has the benefit of real-time diagnosis of anatomic integrity. On the other hand, the magnification offered by the optical system of thoracoscopy allows excellent localization of diaphragmatic defects. This study is the first demonstration of the transdiaphragmatic flow by color Doppler ultrasonography that further directly verifies detected defects by means of video-assisted thoracoscopic surgery.