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Further Evidence That An Acquired Diaphragmatic Defect Is At Fault

Fred L. Lieberman, MD; Robert L. Peters, MD

Arch Intern Med. 1970;125(1):114-117.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

In 1950, a diaphragmatic defect was suggested as the basis for a large pleural effusion suddenly developing in a patient with cirrhosis and ascites. At that time, Williams ¹ demonstrated that diagnostic pneumoperitoneum quickly resulted in the development of a pneumothorax in such a patient. In 1955, Emerson and Davies² demonstrated a small opening in the tendinous portion of the diaphragm at the autopsy of a similar patient. In 1964, Okuda et al³ found similar defects at autopsy in two such patients, and added one more autopsy case in 1967.⁴ In 1966,⁵ we published evidence that the large pleural effusion of cirrhosis was not caused by movement of ascites through diaphragmatic lymphatics, as had been suggested for the pleural effusion of Meigs' syndrome.⁶ We concluded that an opening existed in the diaphragm that allowed ascites to escape into the pleural cavity. These openings were detected . . . [Full Text PDF of this Article]

Author Affiliations
Los Angeles

From the Hepatic Service, John Wesley County Hospital, and the departments of; medicine and pathology, University of Southern California, Los Angeles.

Footnotes
Received for publication Dec 23, 1968; accepted March 5, 1969.

Reprint requests to 2826 S Hope St, Los Angeles 90007 (Dr. Lieberman).

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