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Pleural effusion in a peritoneal dialysis patient
Eun Hui Bae1, Chang Seong Kim, Joon Seok Choi
1Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Chonnam Medical Journal
|November 24, 2011
Summary
A rare complication of continuous ambulatory peritoneal dialysis (CAPD) is a peritoneopleural fistula, causing fluid to leak into the chest. This case highlights diagnostic imaging and a novel treatment approach for this condition.
Area of Science:
- Nephrology
- Pulmonology
- Radiology
Background:
- Continuous ambulatory peritoneal dialysis (CAPD) is a treatment for end-stage renal disease (ESRD).
- Peritoneopleural fistula is a rare but serious complication of CAPD, where dialysis fluid leaks from the abdomen into the chest cavity.
- Diagnosis can be challenging, requiring advanced imaging techniques.
Observation:
- A 34-year-old female on CAPD presented with a dry cough and was found to have massive right hydrothorax.
- Pleural fluid analysis showed a markedly high glucose concentration compared to serum, suggesting a peritoneal origin.
- Imaging studies including CT scan, isotope and contrast peritoneography, and MRI were used to identify the transdiaphragmatic leakage.
Findings:
- The studies confirmed a peritoneopleural fistula, a leak from the peritoneal cavity into the pleural space.
- The high glucose concentration in the pleural fluid was a key indicator of the fistula.
Implications:
- This case underscores the importance of considering peritoneopleural fistula in CAPD patients with unexplained hydrothorax.
- Diagnostic imaging plays a crucial role in identifying the diaphragmatic leak.
- Video-assisted talc pleurodesis is presented as a potential novel treatment option for this condition.
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