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Abstract: PO1317

Late Onset of Sweet Hydrothorax: A Rare Complication of Peritoneal Dialysis

Session Information

Category: Trainee Case Report

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Tobaa, Amel L., Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
  • Andrea, Tyler, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
  • Arora, Swati, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
  • Williams, Harry K., Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
  • Chopra, Bhavna, Allegheny General Hospital, Pittsburgh, Pennsylvania, United States
Introduction

Peritoneal dialysis (PD) has a variety of complications, with diaphragmatic leak causing pleural effusions occurring in 1.6% of cases within 30 days of initiation of PD. We present a case of late-onset right sided pleural effusion, 14 months after initiation of PD, due to spontaneous pleuro-peritoneal leak and the course leading to this rare diagnosis.

Case Description

A 34-year-old female with polycystic kidney disease, bilateral native nephrectomies, and failed kidney transplant receiving PD presented with three days of right sided chest tightness and shortness of breath associated with ultrafiltration failure on PD. Chest x-ray on admission showed a large right-sided pleural effusion (Figure1A).The patient received PD using 2.5% dextrose dianeal; 2 hours after thoracentesis was performed with placement of a chest tube. Fluid analysis revealed a transudative effusion, with glucose of 322 mg/dL with corresponding plasma glucose of 147 mg/dL, consistent with dianeal solution in pleural space. Figure 1B demonstrates passage of the radiotracer from the peritoneal cavity (B) to the pleural space (A), suggestive of right-sided pleuro-peritoneal fistula (C). PD was discontinued and the patient was transitioned to hemodialysis (HD).

Discussion

This case demonstrates a rare complication of PD. Hydrothorax can occur due to increased intra-abdominal pressure causing migration of dialysis fluid from the peritoneal cavity into the pleural space by opening of defects in the diaphragm communicating the two cavities; negative intrathoracic pressure and transiently increased hydrostatic pressure of the dialysate may cause dialysate leak. This phenomenon typically occurs more frequently in women with polycystic kidney disease due to reduced abdominal capacity. Increased glucose in pleural fluid, CT peritoneography and NM scintigraphy are methods of confirming diagnosis. Transition to HD with monitoring for spontaneous closure of the pleuro-peritoneal leak is first line conservative treatment. If the leak persists, surgical repair of the diaphragmatic defect is definitive treatment to resume PD.