Successful treatment of pleuroperitoneal communication with pleurodesis using autologous blood in a patient with severe heart failure undergoing peritoneal dialysis: a case report and brief literature review

Abstract

Background Pleuroperitoneal communication is a potential complication of peritoneal dialysis (PD). Of the various treatment strategies for pleuroperitoneal communication, successful treatment with pleurodesis using autologous blood has rarely been reported. Case presentation A 58-year-old man with end-stage kidney disease secondary to diabetic nephropathy and severe heart failure was placed on PD. He developed right-sided hydrothorax after the commencement of PD. Technetium-99m macro-aggregated human serum albumin peritoneal scintigraphy revealed pleuroperitoneal communication. PD was temporarily discontinued and substituted with hemodialysis. Subsequently, the levels of pleural fluid decreased. However, the resumption of PD exacerbated the hydrothorax. After thoracentesis, 50 mL of autologous blood was instilled into the right pleural cavity. There were no complications related to the procedure. PD was reinitiated 5 days after pleurodesis. Repeated chest X-rays did not depict any evidence of recurrent hydrothorax over the subsequent 10 months. Conclusions Pleurodesis using autologous blood was effective for pleuroperitoneal communication and was evidently safe in our patient. It should be considered in patients with severe heart failure since it is minimally invasive.

Prolonged scintigraphy in the diagnosis of pleuroperitoneal communication

“…The diagnostic yield of peritoneal scintigraphy for PPC using radioactive dialysate ranges from approximately 40–50% 1 to 70%. 2 The rates of radioactive dialysate leakage into the pleural cavity varied considerably in previous reports, from rapid appearance after the injection of radioactive dialysate (around 10 min), 2 to half an hour, 3 and even after several hours. 4 These variations in the diagnostic rates and times to detection by scintigraphy of PPC may relate to the various sizes and locations of the diaphragmatic defects.…”