title: Unilateral recurrent pleural effusion in a renal transplant patient.
abstract: Pleural effusion is a frequent complication in patients undergoing hemodialysis (HD). We report a patient on HD with a novel cause of recurrent unilateral pleural effusion. A 45-year-old female patient on long-term maintenance HD presented to us with recurrent unilateral pleural effusion. She had a history of poor quality dialysis, severe anemia and severe hypertension. Despite correcting these factors and even after undergoing successful renal transplantation, she continued to have recurrent effusion. Left upper extremity venography demonstrated severe stenosis of the subclavian vein and an increased venous flow in the ipsilateral arteriovenous (AV) fistula. Ligation of the AV fistula led to dramatic resolution of the pleural effusion. Hemodialysis patients who develop unexplained pleural effusions ipsilateral to a functioning AV fistula should be investigated for stenosis in the brachiocephalic vein, particularly those patients who have had previous catheterizations of the jugular or subclavian veins on the same side as the effusion. Correcting the stenosis by venous angioplasty and/or ligation of the ipsilateral fistula can dramatically resolve the pleural effusion. A high index of suspicion is required to diagnose this complication for meaningful intervention.
authors.affiliation: Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India. pooja.binnani@yahoo.com
authors.forename: Pooja
authors.initials: P
authors.lastname: Binnani
authors.forename: Ruchi
authors.initials: R
authors.lastname: Gupta
authors.forename: Nikhil
authors.initials: N
authors.lastname: Kedia
authors.forename: M M
authors.initials: MM
authors.lastname: Bahadur
mesh_terms: D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008875:Middle Aged; D010690:Phlebography; D010996:Pleural Effusion / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D012008:Recurrence; D006435:Renal Dialysis / Q000009:adverse effects*; D013396:Suction; D013479:Superior Vena Cava Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D016896:Treatment Outcome