Porous Diaphragm Syndrome with Hepatic Hydrothorax Diagnosed by Decreasing Ascites following Chest Drainage—Report of a Case—

Abstract

A 65-year-old Japanese man, who had been on treatment for resistant massive ascites and hepatic encephalopathy due to alcoholic liver cirrhosis in our hospital, complained of dyspnea on exertion. Radiological findings and a thoracocentesis revealed massive right pleural effusion. Hepatic hydrothorax due to diaphragmatic fenestration was suspected, because massive hepatic ascites decreased following chest drainage, whereas diuretic and thoracic drainage did not improve thoracic effusion. From his clinical course, we determined that internal treatment could not control massive pleural effusion. Under general anesthesia, thoracoscopic surgery was performed after we obtained informed consent. Two tiny pores at the right hemidiaphragm were found, cut and sutured with a GIA stapler and covered with a polyglycolic acid (PGA) sheet. Post operative course was uneventful, and there had been no recurrence of hydrothorax for one year and eight months until his death due to cerebral hemorrhage.