[Progredient dyspnea and poor drainage in a peritoneal dialysis patient -  case 2/2012].
METHODS
We report on a peritoneal dialysis patients who presented with dyspnea, poor drainage and weight gain.


METHODS
A chest x-ray showed a large pleural effusion on the right side. Thoracocentesis revealed a clear protein-devoid fluid with a glucose concentration greater than that of plasma. By intraperitoneal administration of toluidine blue, a pleuroperitoneal leakage was proven.


METHODS
The patient underwent video-assisted thoracoscopy revealing a total of four spots of pleuroperitoneal leakage on the diaphragm after intraperitoneal administration of toluidine blue. Closure was attempted with the aid of a prolene patch which was stiched onto the diaphragm inducing adhesion to the lung. After three months bridging with hemodialysis, the peritoneal dialysis was commenced again without a recurrence of the leakage.


CONCLUSIONS
Pleuroperitoneal leakage can occur during the course of peritoneal dialysis treatment leading to hydrothorax. Video-assisted thoracoscopy and patching of the diaphragm with a prolene mesh can be used to treat these patients.
Medizinische Klinik, Universitätsklinikum Tübingen.
Ferruh
F
Artunc
Michael
M
Sayer
Volker
V
Steger
D000368:Aged; D003964:Diaphragm / Q000601:surgery; D004417:Dyspnea / Q000209:etiology*; D006801:Humans; D006876:Hydrothorax / Q000175:diagnosis / Q000209:etiology / Q000601:surgery; D008297:Male; D010530:Peritoneal Dialysis; D010996:Pleural Effusion / Q000150:complications* / Q000175:diagnosis / Q000601:surgery*; D013906:Thoracoscopy; D014048:Tolonium Chloride / Q000008:administration & dosage; D016896:Treatment Outcome
D014048:Tolonium Chloride