title: Successful induction of peritoneal dialysis in a patient with massive hydrothorax due to pleuroperitoneal communication .
abstract: A 74-year-old woman with liver cirrhosis and chronic kidney disease (CKD) who had complained of chronic abdominal distension due to prominent ascites presented with sudden dyspnea. Chest radiography showed massive right pleural effusion that shifted the mediastinum. Peritoneal scintigraphy using99mTc-macroaggregated albumin revealed pleuroperitoneal communication (PPC). As her hydrothorax was refractory and frequent thoracentesis did not improve her respiratory distress, thoracoscopic surgery was performed for repair of the diaphragm defect. Continuous ambulatory peritoneal dialysis (CAPD) was started soon after surgery because her renal function was progressively worsening, and there was no recurrence of hydrothorax. The chronic abdominal distension resolved as her ascites decreased. In addition, peritoneal protein loss decreased after initiation of peritoneal dialysis (PD). PPC is an uncommon but serious complication of PD, and PD patients with PPC are often forced to discontinue PD. To our knowledge, no report has presented successful PD induction in a patient with evident PPC. We believe that further accumulation of such cases will expand the treatment options for CKD. .
authors.forename: Takahiro
authors.initials: T
authors.lastname: Uchida
authors.forename: Yuji
authors.initials: Y
authors.lastname: Yamada
authors.forename: Toshihiko
authors.initials: T
authors.lastname: Imakiire
authors.forename: Naoki
authors.initials: N
authors.lastname: Oshima
authors.forename: Hiroo
authors.initials: H
authors.lastname: Kumagai
mesh_terms: D000368:Aged; D001201:Ascites / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D003964:Diaphragm / Q000601:surgery*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006876:Hydrothorax / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D007676:Kidney Failure, Chronic / Q000150:complications / Q000628:therapy*; D008103:Liver Cirrhosis / Q000150:complications; D010531:Peritoneal Dialysis, Continuous Ambulatory / Q000379:methods*; D012008:Recurrence; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000628:therapy; D012709:Serum Albumin; D013668:Technetium Tc 99m Aggregated Albumin; D013906:Thoracoscopy; D017971:Tin Compounds
chemical_list: D012709:Serum Albumin; D013668:Technetium Tc 99m Aggregated Albumin; D017971:Tin Compounds; C038216:technetium Tc 99m-Sn aggregated albumin