Peritoneovenous Shunt for Hydrothorax Associated With Ascites

To the Editor .—Hobbs et al (Archives1982;117:1233-1234) described two cases of hydrothorax associated with massive ascites successfully managed by peritoneovenous shunt. Sawyers and I reported the opposite experience two years earlier in the same journal (Archives1980;115:1125-1127). In that report, two cases of hydrothorax were not cured by the shunt, and invasive achievement of pleurodesis was necessary. An additional contrast with the cases of Hobbs et al is that both shunts in the first report were roentgenographically proved functionally intact. Both reports agree that placing a peritoneojugular shunt is a reasonable maneuver if nonsurgical treatment of hydrothorax is unsuccessful. Enough cases have now been described to conclude that this may work. However, its efficacy is not predictable, and, as stated in our report, clearly "no noteworthy experience has been reported to establish how frequently the shunt might be successful in this situation."