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[Progredient dyspnea and poor drainage in a peritoneal dialysis patient - case 2/2012]
Ferruh Artunc1, Michael Sayer, Volker Steger
1Medizinische Klinik, Universitätsklinikum Tübingen.
History And Admission Findings:
We report on a peritoneal dialysis patients who presented with dyspnea, poor drainage and weight gain.
Investigations:
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.
Diagnosis, Treatment And Course:
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.
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