Block in the lymphatics in the parietal pleura seen in spontaneous hydrothorax complicating liver cirrhosis. A case report

Abstract

Spontaneous hydrothorax complicating hepatic cirrhosis is not very infrequent, but the exact cause has not been fully elucidated except for the cases with overt perforation of the diaphragm. This is an account of a 43-year-old male with cirrhosis who developed rightsided pleural effusion of a moderate degree when he had a massive ascites.
Postmortem examination disclosed several striated blackish nodules consisting of collagen fiber with surrounding infiltration of lymphocytes and macrophages; they represented silicosis of the pleural lymphatics. No defect or bleb was seen in the diaphragm. These findings strongly suggest that in this patient, the lymph drainage via the intercostal lymphatics had been impeded because of a block due to silicotic granulomas, resulting in lymph stasis and subsequently hydrothorax.