Cirrhotic Hydrothorax

Abstract

In 1950, a diaphragmatic defect was suggested as the basis for a large pleural effusion suddenly developing in a patient with cirrhosis and ascites. At that time, Williams¹demonstrated that diagnostic pneumoperitoneum quickly resulted in the development of a pneumothorax in such a patient. In 1955, Emerson and Davies²demonstrated a small opening in the tendinous portion of the diaphragm at the autopsy of a similar patient. In 1964, Okuda et al³found similar defects at autopsy in two such patients, and added one more autopsy case in 1967.⁴In 1966,⁵we published evidence that the large pleural effusion of cirrhosis was not caused by movement of ascites through diaphragmatic lymphatics, as had been suggested for the pleural effusion of Meigs' syndrome.⁶We concluded that an opening existed in the diaphragm that allowed ascites to escape into the pleural cavity. These openings were detected