Scintigraphic Demonstration of Trans-Diaphragmatic Migration of Ascites

There are many disease in which pleural effusion develops without direct extension of the offending organism or cell into the thorax. They are intraabdominal or retroperitoneal in location and involve the transfer of fluid from below the diaphragm into the pleural space. Pleural involvement from subphrenic inflammation is easy to understand, but the precise mechanism of migration of noninflammatory ascites through diaphragm is not clear in the patients with liver cirrhosis, Meigs's syndrome or peritoneal dialysis. We report a case where trans-diaphragmatic migration of peritoneal fluid has been demonstrated in a patient with peritoneal dialysis by scintigraphic method, with a brief review of literatures about the possible mechanisms. Scintigraphic study can show the source of pleural effusion and can suggest the mechanism of migration of ascites in the patients with liver cirrhosis, Meigs' syndrome, and also in patients with peritoneal dialysis. And thus we can manage the patient properly by coping with possible situations if hydrothorax developed.