title: A large pleural effusion in a patient receiving peritoneal dialysis.
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.
authors.affiliation: Department of Medicine Surgery Radiology, Rush University Medical Center, Chicago, Illinois 60607, USA. Karen_Tapawan@rush.edu
authors.forename: Karen
authors.initials: K
authors.lastname: Tapawan
authors.forename: Elaine
authors.initials: E
authors.lastname: Chen
authors.forename: Natalie
authors.initials: N
authors.lastname: Selk
authors.forename: Edward
authors.initials: E
authors.lastname: Hong
authors.forename: Sumeet
authors.initials: S
authors.lastname: Virmani
authors.forename: Robert
authors.initials: R
authors.lastname: Balk
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D010996:Pleural Effusion / Q000209:etiology* / Q000473:pathology / Q000628:therapy