SHM Converge Scientific Abstract ePoster Gallery-A Rare Cause of Hydrothorax: Peritoneal Dialysis

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This case describes a 50-year-old woman with end-stage renal disease on peritoneal dialysis (PD), congestive heart failure, and recent invasive pulmonary aspergillosis who presented with three days of progressive shortness of breath and right-sided chest pain. On exam, she was hypoxic, had absent breath sounds on the right, and mild tenderness near the PD site. Labs showed severe chronic kidney dysfunction, elevated BNP, mild leukocytosis, and mildly elevated LDH, but no strong signs of infection or acute heart failure.<br /><br />Imaging revealed a large right pleural effusion with near-complete opacification of the right lung. Her symptoms improved after thoracentesis, but when PD was restarted, her dyspnea and oxygen requirement returned, and repeat imaging showed rapid reaccumulation of the pleural effusion. A nuclear medicine study confirmed a pleuro-peritoneal communication, establishing the diagnosis of hydrothorax due to a pleuro-peritoneal leak from PD.<br /><br />Hydrothorax is a rare complication of peritoneal dialysis, occurring in about 1.6% to 10% of patients. It should be suspected in PD patients—especially within the first year—who develop non-toxic dyspnea or chest pain. The mechanism is usually related to increased intra-abdominal pressure from dialysate forcing fluid into the pleural space through congenital or acquired defects.<br /><br />The patient was treated by stopping PD and transitioning to hemodialysis via a central line. The case highlights the importance of recognizing PD-related hydrothorax early, since it can cause recurrent pleural effusions, inadequate dialysis, and serious respiratory compromise.

Asset Subtitle

Denis Nguyen

Meta Tag

Author List Denis Nguyen, Matthew Cerasale

Category Clinical Vignettes

Concept Hydrothorax

Concept Pleuro-Peritoneal Leak

Concept Peritoneal Dialysis

Concept Pleural Effusion

Concept Dyspnea

Distinguished Non-Finalist

Presenter Organization UChicago Pritzker School of Medicine

Presenting Author Denis Nguyen

Track Adult

Keywords

peritoneal dialysis

hydrothorax

pleuro-peritoneal leak

pleural effusion

end-stage renal disease

thoracentesis

shortness of breath

chest pain

hemodialysis

pleuro-peritoneal communication

Hydrothorax

Pleuro-Peritoneal Leak

Peritoneal Dialysis

Pleural Effusion

Dyspnea