Dr. Kallel Faouzi, Consultant in Nuclear Medicine, King Faisal Hospital, Taif-Saudi Arabia

A 78-year-old female with cirrhosis presented with ascites and persistent right-sided pleural effusion. Hepatic hydrothorax was suspected, and peritoneal scintigraphy was performed after intraperitoneal injection of 259 MBq of 99mTc-nano colloids. Dynamic early and static images centered on the thorax and abdomen were acquired at 1, 1:30, and 2 hours post-injection.

Progressive accumulation of the radio-pharmaceutical in the right pleural space (seen above on 1 hr and 2 hr images), in the pattern of known pleural effusion, is consistent with hepatic hydrothorax. The patient was treated successfully with talc pleurodesis.

Ajmi S, Hassine H, Guezguez M, Elajmi S, Mrad Dali K, Karmani M, Zayane A, Essabbah H. Isotopic exploration of hepatic hydrothorax: ten cases, Gastroenterol Clin Biol. 2004 May;28(5);462-6.

Mittal BR, Maini A, Das BK. Peritoneopleural communication associated with cirrhotic ascites: scintigraphic demonstration. Abdom Imaging. 1996 Jan-Feb;21(1):69-70.