1. Mechanical Pleurodesis Aided by Peritoneal Drainage: Procedure for Hepatic Hydrothorax 
Patrick G. Northup, MD, R. Christopher Harmon, MD, PhD, Timothy L. Pruett, MD, Worthington G. Schenk, MD, Thomas M. Daniel, MD, Carl L. Berg, MD 
The Annals of Thoracic Surgery 
Volume 87, Issue 1, Pages (January 2009)
DOI: /j.athoracsur
Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

2. Fig 1
Diagrammatic representation of combined pleural and peritoneal drainage procedure. 1. Placement of peritoneal drainage catheter and chest tube. 2. Aspiration of ascites. 3. Simultaneous aspiration of ascites and pleural fluid to allow apposition of visceral and parietal pleura and thus closure of defect(s) in diaphragm.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

3. Fig 2
Positive pressure causes reversal of pressure gradient for passage of ascites through the diaphragm. Arrows indicate pressure-flow. (CPAP = continuous positive airway pressure.)
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions

4. Fig 3
Representative chest radiographs from one of the patients who underwent the procedure (patient 3). Image (A), taken preoperatively, shows a large right-sided hydrothorax occupying the entire right hemithorax. Image (B) was taken on postoperative day 1 and shows improvement in the hydrothorax and the chest tube and peritoneal drain in place (arrows). There is also some right-sided airspace disease on this image which was treated as pneumonia. Image (C), obtained on the day of discharge, shows near complete resolution of the hydrothorax and removal of the drains.
The Annals of Thoracic Surgery  , DOI: ( /j.athoracsur )
Copyright © 2009 The Society of Thoracic Surgeons Terms and Conditions