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Abstract: FR-PO485

A Rare Case of Bilateral Pleuroperitoneal Leaks in a Patient on Peritoneal Dialysis

Session Information

Category: Dialysis

  • 702 Dialysis: Home Dialysis and Peritoneal Dialysis


  • Gutty, Bhamini, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom
  • Mahdi, Amar Monaf, University Hospitals Birmingham NHS Foundation Trust, Birmingham, Birmingham, United Kingdom

We present a case of bilateral pleuroperitoneal leaks in a young patient on peritoneal dialysis (PD). Pleuroperitoneal leak is a rare but important complication of PD, occurring in 1%-2% of patients. It is thought to develop due to increased intra-abdominal pressure on a background of congenital or acquired diaphragmatic defects. Patients typically present with dyspnoea but may have a reduction in ultrafiltration. Pleural effusion due to pleuroperitoneal leak is usually unilateral, most commonly on the right. Left sided pleuroperitoneal leaks are uncommon. It is thought that diaphragmatic defects are protected on the left side by the heart.

Case Description

This 28-year-old female, on automated PD for 9 months, presented with dyspnoea and a reduction in ultrafiltration. Chest radiograph revealed moderate bilateral pleural effusions, in a euvolaemic patient with no prior history of heart disease.

She underwent diagnostic bilateral thoracocentesis which revealed transudative pleural effusions. Left and right pleural aspirates showed a glucose concentration of 16.3 mmol/L and 18.1 mmol/L respectively. Both showed negligible lactate dehydrogenase (<30 U/L) and protein levels (<8 g/L). A paired serum glucose was 3.6 mmol/L (normal range 3.9 - 5.8 mmol/L) and protein was 60 g/L (normal range 60 – 80 g/L). The presence of high pleural fluid glucose relative to serum glucose confirmed the diagnosis of bilateral pleuroperitoneal leaks.

She was managed conservatively with peritoneal rest and transitioned to intermittent haemodialysis. PD was discontinued permanently with subsequent removal of her peritoneal catheter. A chest radiograph two weeks later showed complete resolution of the bilateral pleural effusions.


By having a high index of suspicion in this patient with bilateral pleural effusions, an early diagnosis of bilateral pleuroperitoneal leaks was made. Although pleuroperitoneal leaks are typically right sided, it is important to recognise that clinical presentation may vary and patients can present with bilateral pleuroperitoneal leaks.