Abstract: PUB069
When the Pleural Fluid Turns Blue: Role of Methylene Blue in Evaluating Pleuroperitoneal Fistula in Patients on Peritoneal Dialysis
Session Information
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- David, Alexcis, West Virginia University, Morgantown, West Virginia, United States
- Miller, Brett Anthony, West Virginia University, Morgantown, West Virginia, United States
- Shawwa, Khaled, West Virginia University, Morgantown, West Virginia, United States
Introduction
Pleuroperitoneal fistula is an uncommon complication of peritoneal dialysis, affecting less than 2% of patients and most often presenting as a right-side pleural effusion. Diagnosis through peritoneography or scintigraphy may not always be readily available.
Case Description
A 51-year-old female with end stage renal disease initiated continuous cycling peritoneal dialysis (CCPD) 2 months prior to hospitalization. She presented with progressive dyspnea for 2 weeks and was found to have a large right-side pleural effusion prompting right chest tube placement. Her history included bilateral pleural effusions 10 years prior to presentation related to pneumonia and volume overload, requiring bilateral chest tubes. This history raised concern for preexisting diaphragmatic weakness. Given ongoing PD and unilateral effusion, pleuroperitoneal fistula was suspected. A bedside diagnostic test was performed by instilling 10 mL methylene blue in 2 L 1.5% dialysate intraperitoneally. Blue-green pleural drainage was observed via chest tube prior to completion of dialysate instillation, confirming communication. Chest radiography confirmed appropriate intrathoracic placement of chest tube.
The patient experienced abdominal cramping during methylene blue instillation; this was relieved with analgesic administration.
Discussion
PD patients with new unilateral pleural effusions, especially soon after PD initiation, should be evaluated for pleuroperitoneal fistula. Intraperitoneal methylene blue allows for rapid bedside confirmation, avoiding more resource-intensive imaging, particularly when pleural drainage is already present. However, there may be transient abdominal discomfort; this can be minimized by considering lower dye concentrations and ensuring availability of PRN analgesia.