The morphology of diaphragmatic defects in hepatic hydrothorax: Thoracoscopic finding

Background: Until now, the pathophysiology of hepatic hydrothorax has been moot. We discuss (on the basis of gross videothoracoscopy findings in 11 cases and the literature) the pathogenesis and clinical presentation of this complex condition. Methods: We prospectively studied 11 patients (age, 31-73 years; 6 men and 5 women) with refractory hepatic hydrothorax (Child-Pugh class B-C) who underwent thoracoscopic repair of diaphragmatic defects. The diaphragmatic defects were examined intraoperatively. Results: The diaphragmatic defects stemming from hepatic hydrothorax were classified into 4 morphologic types: type 1, no obvious defect (I patient); type 11, blebs lying on the diaphragm (4 patients); type 111, broken defects (fenestrations) in the diaphragm (8 patients); and type IV, multiple gaps in the diaphragm (I patient). The type of diaphragmatic defect did not correlate with the volume occupied by the pleural effusion in the preoperative chest radiograms. Conclusions: The finding of this study allowed hepatic hydrothorax pathophysiology to be directly visualized, and further studies concerning the treatment of hepatic hydrothorax might be based on these mechanisms.