A Rare Case of Unilateral Pleural Effusion in a Pediatric Patient on Chronic Peritoneal Dialysis: Is it a Pleuroperitoneal Leakage?

Non-infectious complications of peritoneal dialysis (PD) are relatively less common than infectious complications but are a potentially serious problem in patients on chronic PD. Here, we present a case of a non-infectious complication of PD in a 13-year-old boy on chronic PD who presented with symptoms such as hypertension, edema, dyspnea, and decreased ultrafiltration. Chest and abdominal radiography showed pleural effusion and migration of the PD catheter tip. Laparoscopic PD catheter reposition was performed because PD catheter malfunction was suspected. However, pleural effusion relapsed whenever the dialysate volume increased. To identify peritoneal leakage, computed tomography (CT) peritoneography was performed, and a defect of the peritoneum in the left lower abdomen with contrast leakage to the left rectus and abdominis muscles was observed. He was treated conservatively by transiently decreasing the volume of night intermittent PD and gradually increasing the volume. At the 2-year follow-up visit, the patient had not experienced similar symptoms. Patients on PD who present with refractory or recurrent pleural effusion that does not respond to therapy should be assessed for the presence of infection, catheter malfunction, and pleuroperitoneal communication. Thoracentesis and CT peritoneography are useful for evaluating pleural effusion, and timely examination is important for identifying the defect or fistula.

Two Cases of Hydrothorax Associated with Pleuroperitoneal Communications Proved by CT Peritoneography and Peritoneoscintigraphy / 대한신장학회잡지

With the increasing use of PD as a replacement therapy in chronic renal failure, the number of complications related to PD also has increased. One of these is hydrothorax associated with pleuroperitoneal communications. Diagnosis is based upon confirming that the fluid in pleural space is dialysate. The chemical characteristics of the pleural fluid can help diagnose dialysate in pleural space. One can use dialysate mixed with dye (methylene blue, indigo). Peritoneographies with contrast and radionucleotides are safe, accurate, and reliable methods of diagnosing peritoneal defects. While these substances do not damage the peritoneum, their diffusion is low. We report 2 cases of hydrothorax associated with pleuroperitoneal communications in CAPD patients. We employed CT peritoneography and peritoneoscintigraphy to diagnose the hydrothorax associated with pleuroperitoneal leak.

Abdominal Wall Leakage in CAPD Patient Confirmed by CT Peritoneography / 대한신장학회잡지

Abdominal wall leakage of dialysate in continuous ambulatory peritoneal dialysis (CAPD) patients is uncommon complication. We experienced one case of abdominal wall leakage in CAPD patient confirmed by CT peritoneography. She complained weight gain, decreased ultrafiltration volume, and localized abdominal wall edema without clinical evidence of hernia. CT peritoneography of the abdomen showed leakage of contrast dye from the site of insertion of the CAPD catheter into the anterior abdominal wall. The dialysate was completely drained and CAPD was discontinued. She was switched temporally to hemodialysis and abdominal wall edema disappeared. When CAPD was restarted seven days later, the edema appeared. After CAPD catheter was removed and reinserted at the opposite site, she returned to CAPD without leakage.