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A Large Pleural Effusion in a Patient Receiving Peritoneal Dialysis
Author(s) -
Tapawan Karen,
Chen Elaine,
Selk Natalie,
Hong Edward,
Virmani Sumeet,
Balk Robert
Publication year - 2011
Publication title -
seminars in dialysis
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.899
H-Index - 78
eISSN - 1525-139X
pISSN - 0894-0959
DOI - 10.1111/j.1525-139x.2011.00859.x
Subject(s) - medicine , pleurodesis , hydrothorax , thoracentesis , peritoneal dialysis , surgery , chylothorax , thoracoscopy , pleural effusion , radiology , ascites
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.