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      Pleural Effusion in a Peritoneal Dialysis Patient

      case-report

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          Abstract

          A 34-year-old female presented with end-stage renal disease (ESRD) treated by peritoneal dialysis (CAPD) complained of a dry cough. Chest X-ray and chest computed tomography (CT) scan revealed massive right hydrothorax. Because the glucose concentration of pleural fluid was markedly high compared with that of serum, we performed isotope and contrast peritoneography. We used CT for localizing it. MRI was also trying to show transdiaphragmatic leakage in peritoneoflural fistula. Temporary discontinuation of CAPD, tetracycline instillation into the pleural space and surgical patch grafting of the diaphragmatic leak have all been described. A novel method may be video-assisted talc pleurodesis.

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          Pathogenesis and management of hydrothorax complicating peritoneal dialysis.

          Susanna M K Chow, Cheuk-Chun Szeto (2004)
          Hydrothorax complicating continuous ambulatory peritoneal dialysis (CAPD) appears in approximately 2% of all patients. Recent advances in minimally invasive surgery have revolutionized the treatment strategy of this condition. Hydrothorax in CAPD is most commonly secondary to a pleuro-peritoneal communication. Thoracocentesis with biochemical analysis of pleural fluid is the first-line investigation. In uncertain cases, or when there is a clinical need to demonstrate the anatomy of the communication, an imaging approach such as peritoneal scintigraphy is required. Cessation of peritoneal dialysis is indicated if diagnosis of the complication is confirmed. For half of the cases, a conservative approach allows reinstitution of CAPD, presumably because of spontaneous resolution of the leakage. A small-volume exchange is a feasible alternative for children. In patients who failed conservative treatment, video-assisted thoracoscopic pleurodesis or diaphragmatic repair or both allows most of them to continue with CAPD. Chemical pleurodesis is probably indicated for those who failed conservative treatment in centers without video-assisted thoracoscopic support. Currently, only a minority of patients will require open thoracotomy. Once hydrothorax secondary to pleuro-peritoneal communication is confirmed in CAPD patients, temporary cessation of peritoneal dialysis remains the first-line treatment. Current evidence shows that video-assisted thoracoscopic pleurodesis or repair should be the treatment of choice in patients who failed conservative management.
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            Dry cough in a CAPD patient.

            Doreen Reimann, Kay Herbrig, Peter Gross … (2003)
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              The persisting pneumatoenteric recess and the infracardiac bursa: possible role in the pathogenesis of right hydrothorax complicating peritoneal dialysis.

              F Gagnon, Deirdre E Daniels (2003)
              Hydrothorax, an uncommon complication of peritoneal dialysis (PD), results from the migration of dialysis fluid under pressure from the peritoneal cavity into the pleural space. The exact site of the transdiaphragmatic fluid leak remains obscure, but the right-sided predominance of the hydrothorax points to the presence of abnormalities in the right hemidiaphragm. Such abnormalities have occasionally been described. In a recent case of acute massive right hydrothorax at the start of PD, the autopsy revealed extensive changes of amyloidosis that were comparable in both hemidiaphragms, prompting us to revisit the accepted explanation for right hydrothorax. We propose that an embryonic remnant--namely, the persisting pneumatoenteric recess and the infracardiac bursa--provides a passage connecting the peritoneal cavity to the right pleural space. The potential presence of this mechanism is consistent with the recognized clinical features of right hydrothorax complicating PD. This proposed route for dialysis fluid to form a right hydrothorax during PD can be investigated by currently available high-definition imaging techniques. This novel mechanism may also be involved in the pathogenesis of right hydrothorax observed in other medical conditions with tense ascites (liver cirrhosis, Meigs syndrome).
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                Author and article information

                Journal
                Journal ID (nlm-ta): Chonnam Med J
                Journal ID (publisher-id): CMJ
                Title: Chonnam Medical Journal
                Publisher: Chonnam National University Medical School
                ISSN (Print): 2233-7385
                ISSN (Electronic): 2233-7393
                Publication date (Print): April 2011
                Publication date (Electronic): 26 April 2011
                Volume: 47
                Issue: 1
                Pages: 43-44
                Affiliations
                Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
                Author notes
                Corresponding Author: Soo Wan Kim. Department of Internal Medicine, Chonnam National University Medical School, 8 Hakdong, Dong-gu, Gwangju 501-757, Korea. TEL: +82-62-220-6271, FAX: +82-62-225-8578, skimw@ 123456chonnam.ac.kr
                Article
                DOI: 10.4068/cmj.2011.47.1.43
                PMC ID: 3214860
                PubMed ID: 22111056
                SO-VID: b1d647f0-3df4-4f3b-bb59-5e0c7166ff4c
                Copyright © © Chonnam Medical Journal, 2011
                License:

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License ( http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                Date received : 28 March 2011
                Date accepted : 07 April 2011
                Categories
                Subject: Images in Clinical Medicine

                ScienceOpen disciplines: Medicine
                Keywords: pleural effusion,kidney,dialysis
                Data availability:
                ScienceOpen disciplines: Medicine
                Keywords: pleural effusion, kidney, dialysis

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