The curious right-sided predominance of peritoneal dialysis-related hydrothorax

Guest, Steven

doi:10.1093/ckj/sfu141

Cited by 21 publications

(28 citation statements)

References 31 publications

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“…Right-sided predominance of hydrothorax, as seen in our findings, is consistent with findings in the literature which suggest the higher likelihood of a presence of right hemi diaphragm abnormalities. [ 5 , 19 , 20 ] Gagnon and Daniels proposed that an embryonic remnant (the persisting pneumato-enteric recess and infracardiac bursa) provides a passage connecting the peritoneal cavity to the right pleural space. [ 14 ] Histologic findings from resected diaphragm include lack of common tissue, tendons, skeletal muscle tissues, and displacement by fibrous connective tissue on this side of the diaphragm.…”

Section: Discussionmentioning

confidence: 99%

“…[ 14 ] It is also proposed that as the right diaphragm contracts, the relatively firm liver capsule acts as a piston, driving fluid through the porous defects on the right diaphragm unlike on the left where it is softer and more compliant thus not creating this piston-like force. [ 19 ] Furthermore, the presence of the heart on the left may be protective to the left diaphragm. [ 13 ]…”

Section: Discussionmentioning

confidence: 99%

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Scintigraphic peritoneography in the diagnosis of pleuroperitoneal leak complicating peritoneal dialysis

Harry¹,

Nyakale²,

Tinarwo

2020

Medicine

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A pleuroperitoneal leak (PPL) is a relatively rare complication of peritoneal dialysis (PD) and early diagnosis is essential. Patients suspected of a PPL usually present with dyspnea (marked during inflow of PD fluid) and tend to have transudative high glucose pleural effusions. The PPL scintigraphy (PPLS) is one of the methods for objectively proving a PPL. The effectiveness of PPLS as a noninvasive method of evaluating a suspected PPL and its effectiveness in the exclusion of a leak in patients with similarly presenting comorbidities was assessed. Patients suspected to have a PPL were considered for PPLS based on clinical presentation and pleural fluid analysis. Radiopharmaceutical was administered into the peritoneum via the dialysis port with the patient lying supine and immediate dynamic followed by delayed statics were acquired. Of the 27 scans reviewed, 70% were found to be positive with majority detected within 12 minutes of radiopharmaceutical administration with a high predominance occurring in the right chest ( P < .001). In PPLS-positive patients, when both chest X-rays and planar agreed on showing the right-sided chest predominance, the highest measurements of the pleural glucose:serum glucose ratio were recorded. A statistically significant correlation between the outcome of the scan and final decision on patient management was noted ( P < .01). The PPLS is an effective diagnostic tool for assessing PPLS. However, multicenter studies investigating its added value over other conventional methods are needed to establish it as a highly relevant diagnostic tool.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Scintigraphic peritoneography in the diagnosis of pleuroperitoneal leak complicating peritoneal dialysis

Harry¹,

Nyakale²,

Tinarwo

2020

Medicine

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“…In addition to porosity at the right hemidiaphragm, right-side predominance of this syndrome is explained by the following three reasons [1,2]. First, peritoneal circulation produced by intestinal peristalsis is the preferential flow of peritoneal fluids from the pelvis to the right upper quadrant.…”

Section: Discussionmentioning

confidence: 99%

“…One of the mechanisms of developing a hole in the diaphragm is through increasing intra‐abdominal pressure by ascites. Diaphragmatic thinning may also occur because of malnutrition caused by malignancies, where collagen bundles of the tendinous portion of the diaphragm are broken off . In this report, we present a case of porous diaphragm syndrome in which the patient had massive ascites due to recurrent thymoma.…”

Section: Introductionmentioning

confidence: 91%

Porous diaphragm syndrome with recurrent thymoma

Ota

Hasegawa

Okabe

et al. 2018

Respirology Case Reports

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Porous diaphragm syndrome describes a defect in the diaphragm in which substances pass from the peritoneal cavity to the pleural space. Defects may be congenital or acquired. Acquired defects are caused by the thinning and eventual splitting of collagen fibres in the tendinous part of the diaphragm. We report a case of porous diaphragm syndrome with recurrent thymoma that presented with massive ascites. Increasing intra‐abdominal pressure by ascites and diaphragmatic thinning due to malnutrition by malignancies resulted in the formation of an artificial hole. Thoracentesis changed the balance of hydrostatic pressure, which initiated the influx of a large volume of ascites to the pleural cavity through a hole in the diaphragm.

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“…The primary etiology of hydrothorax in the PD patient is thought to be pleuro-peritoneal communication due to high peritoneal pressure upon dialysis in the presence of congenital or acquired defects in the diaphragm [59,61,62], although some cases are brought on by a malfunctioning or malpositioned catheter [63]. Notably, the presence of hydrothorax is right-sided in 90% of cases, as the left side of the diaphragm is partially supported by the heart and pericardium [64][65][66].…”

Section: Hydrothoraxmentioning

confidence: 99%