Diaphragmatic defect as a cause of massive hydrothorax in cirrhosis of liver

A 56-year-old woman with a 2-year history of cirrhosis of the liver and frequent right pleural effusion was admitted with intractable shortness of breath. Chest x-ray examination showed marked pleural effusion of the right lung field with a shift of the mediastinum to the left. Ascites was not conspicuous. Except for the liver cirrhosis, there was no clinical evidence of other underlying diseases. The patient died with a relatively short course after hospitalization. At autopsy, an apparent bleb with 1-mm hole in the tendinous portion of the right diaphragm was noted. We suggest that the ascitic fluid directly crossed the diaphragmatic defect to the pleural cavity, which contributed to the hydrothorax. In this article we review the pertinent literature.