Acute hydrothorax complicating peritoneal dialysis: a case report

Abstract

IntroductionAcute hydrothorax is an uncommon but a well-recognized complication of peritoneal dialysis. No single test is definitive for diagnosis. Although it is not a life-threatening condition, hydrothorax often requires abandonment of peritoneal dialysis. Delay in diagnosis can lead to worsening of the clinical status.Case PresentationA 33-year-old Caucasian woman with lupus, who was successfully treated with temporary peritoneal dialysis 17 years previously, presented with acute dyspnea and a right pleural effusion after recommencing peritoneal dialysis. Investigations eliminated infective, cardiac, and primary respiratory causes. Peritoneal dialysis-related hydrothorax was suggested by biochemistry, and a pleuroperitoneal leak was definitively confirmed by using a Tc-99 m DTPA (diethylene triamine penta-acetic acid) scintigraphy scan. Subsequently, she underwent video-assisted thoracoscopy-guided talc pleurodesis and was able to return successfully to peritoneal dialysis.ConclusionAlthough our case is not the first report that describes the occurrence of acute hydrothorax in peritoneal dialysis, it is an important condition to recognize for the wider general medical community. Furthermore, this case demonstrates that peritoneal dialysis can be continued with a hydrothorax, provided the underlying cause can be corrected. We review the literature pertaining to the utility and reliability of different diagnostic approaches to hydrothorax.

Atypical Pleural Effusions in Patients on Peritoneal Dialysis

“…The cause of PD fluid leaks are considered to be mainly due to congenital or acquired diaphragmatic defects, with very occasional disorders of lymphatic drainage or severe overfill with high pleuroperitoneal pressure gradients [5]. The migration of dialysate through acquired defects is said to be unidirectional and can occur as a result of the negative pleural pres- …”

Diagnosis by Peritoneal scintigraphy of Peritoneal Dialysis–Associated Hydrothorax in an Infant

“…However, those investigations do not indicate the origin of the fluid (13), and exposure to radiation from the computed tomography imaging is considerable.…”

Mechanical Complications of Peritoneal Dialysis

“…Common methods of diagnosis are chest CT [68], X-ray imaging [70], or ultrasonography [68]. These methods can confirm the presence of fluid in the pleural space, but do not allow for appreciation of the underlying etiology of a diaphragmatic defect, which can lead to an alternate diagnosis [71]. Additionally, the presence of increased glucose levels in the pleural fluid is suggestive of a pleuro-peritoneal communication, although this does not manifest in all patients and should not be relied upon as the sole means of diagnosis [59,70,72].…”