A large pleural effusion in a patient receiving peritoneal dialysis

Semin Dial. Sep-Oct 2011;24(5):560-3. doi: 10.1111/j.1525-139X.2011.00859.x. Epub 2011 Apr 11.

Abstract

Hydrothorax as a complication of peritoneal dialysis (PD) is a rare but recognized event. Proposed mechanisms for the development of a pleuro-peritoneal communication include congenital diaphragmatic defects, acquired weakening of diaphragmatic fibers caused by high intra-abdominal pressures during peritoneal dialysis, and impairments in lymphatic drainage. Pleural fluid analysis and diagnostic imaging assist in differentiation from other causes of pleural effusion. Nearly 50% of patients with this diagnosis have resolution of hydrothorax after temporary cessation of PD with interim hemodialysis for 2-6 weeks. Historically, other treatment options have included conventional pleurodesis and open thoracotomy with direct repair, producing variable results. With the advent of video-assisted thoracoscopy (VATS), surgical repairs and pleurodesis are now frequently performed under direct visualization with minimal invasiveness. We report a case of hydrothorax in a patient after recent introduction to peritoneal dialysis. Pleuro-peritoneal communication was documented with thoracentesis and radionuclide scanning. VATS pleurodesis with talc was performed. Repeat scintigraphy performed 1 week after the procedure revealed no residual communication, and patient was able to resume PD without further complications.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Female
  • Humans
  • Peritoneal Dialysis / adverse effects*
  • Pleural Effusion / etiology*
  • Pleural Effusion / pathology
  • Pleural Effusion / therapy