Bilateral Pleural Effusion in Continuous Ambulatory Peritoneal Dialysis Managed by Vats Pleurodesis.

Pleuroperitoneal leak as a cause of pleural effusions in peritoneal dialysis is a rare but important complication to consider in continuous ambulatory peritoneal dialysis (CAPD) patients presenting with recurrent progressive dyspnoea. Generally, these effusions are unilateral and right-sided, resulting in shortness of breath and reduced ultrafiltration volume, which are initially managed by peritoneal rest. We describe a case of bilateral pleural effusions in a 57-year-old female on chronic CAPD who developed recurrent progressive dyspnoea but maintained adequate dialysis output. A chest radiograph revealed bilateral pleural effusions with high glucose content, and scintigraphy confirmed the existence of a definite pleuroperitoneal communication. She was managed by temporary substitution to haemodialysis, followed by suturing of the shunt and successful video-assisted thoracoscopic surgery (VATS) pleurodesis with an aldehyde-based surgical glue. Unexplained recurring dyspnoea in chronic CAPD should raise the suspicion of a possible pleuroperitoneal leak, even in patients without an apparent loss of ultrafiltration. Pleurodesis using an aldehyde-based adhesive was effective and tolerated well by our patient and may be considered in managing cases of recurrent pleural effusion. LEARNING POINTS: Recurrent dyspnoea in a chronic peritoneal dialysis patient should raise the diagnosis of a possible pleuroperitoneal leak, even if no apparent loss of ultrafiltration was observed.Minimally invasive surgical pleurodesis using surgical adhesive can be considered in cases of refractory pleuroperitoneal leak.

Delayed pleuroperitoneal leak in an otherwise uncomplicated course of peritoneal dialysis.

Key Clinical Message: Pleuroperitoneal leaks are rare and normally arise as an early complication in peritoneal dialysis. This case illustrates the importance of considering pleuroperitoneal leaks as a cause for pleural effusions-even if peritoneal dialysis has been longstanding and uncomplicated. Abstract: A 66-year-old male on peritoneal dialysis for 15 months presented with dyspnoea and low ultrafiltration volumes. Chest radiography revealed a large right-sided pleural effusion. Pleural fluid sampling and peritoneal scintigraphy confirmed a pleuroperitoneal leak.

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.