Abstract
A variety of procedures are used to demonstrate transdiaphragmatic transport of peritoneal fluid. Ideally, the procedure should be safe, reliable and generally available. At present, three procedures are used for this purpose: I) The study of dialysate, serum and pleural fluid for glucose, protein and LDH compoDents, 2) the intraperitoneal instillation of methylene blue dye, and 3) radionuclide scanning. Our study of five patients with hydrothorax suggests that these three procedures differ in risk factors, availability and reliability. Radionuclide scanning made the correct diagnosis in three of three cases where it was performed; the other two procedures were associated with false negative and positive results and a high incidence of side effects.
We have concluded that radionuclide scanning is a safe and reliable procedure by which to demonstrate a pleuroperitoneal communication. Methylene blue test should be abandoned because of its toxic side effects and inconclusive results.
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