SHM Converge Scientific Abstract ePoster Gallery-When Peritoneal Fluid Rains, It Pours: A Case of Dialysis-Related Hydrothorax

Pdf Summary

This case report describes a rare but serious complication of peritoneal dialysis: hydrothorax caused by pleuroperitoneal communication. A 29-year-old woman with end-stage renal disease of unknown cause had started daily peritoneal dialysis but was poorly compliant. Five months later, she presented with cough and pleuritic chest pain, and her initial chest x-ray showed left upper lobe pneumonia. During hospitalization, emergent peritoneal dialysis was restarted for severe hyperkalemia (K 7.7 mEq/L). Two days later, she developed acute worsening dyspnea and cough, and repeat imaging revealed a new large right pleural effusion with mediastinal shift.<br /><br />An infectious, cardiac, respiratory, and neoplastic evaluation was negative. Thoracentesis supported hydrothorax: the pleural fluid looked like peritoneal fluid, was transudative by Light’s criteria, and had a pleural-to-serum glucose ratio of 4. Because she had recently started peritoneal dialysis, the most likely cause was leakage of dialysate into the thorax through a diaphragmatic defect or fistula.<br /><br />The report notes that dialysis-related hydrothorax occurs in about 1% of peritoneal dialysis patients and is often right-sided because the right hemidiaphragm is more porous. Diagnostic workup should include pleural fluid analysis and, when needed, confirmatory imaging such as contrast-enhanced ultrasonography or scintigraphy. First-line treatment is stopping peritoneal dialysis and switching to hemodialysis, with many cases resolving within 2 to 8 weeks. More conservative strategies, such as repeated drainage while continuing PD, and more invasive surgical approaches are also described.<br /><br />In this case, the patient was transitioned to hemodialysis, and the pleural effusion initially resolved. She was discharged to continue hemodialysis for 8 weeks with nephrology follow-up for longer-term management.

Asset Subtitle

Ethan Molitch-HoU

Meta Tag

Author List Ethan Molitch-HoU, Felicia R. d'Souza, Muriel R. Battaglia

Category Clinical Vignettes

Concept Peritoneal Dialysis-Related Hydrothorax

Concept Pleuroperitoneal Communication

Concept Hemodialysis

Concept Peritoneal Dialysis

Concept Pleural Effusion

Distinguished Non-Finalist

Presenter Organization University of Chicago

Presenting Author Ethan Molitch-HoU

Track Adult

Keywords

peritoneal dialysis

hydrothorax

pleuroperitoneal communication

pleural effusion

dialysate leak

end-stage renal disease

thoracentesis

transudative effusion

hemodialysis

diaphragmatic defect

Peritoneal Dialysis-Related Hydrothorax

Pleuroperitoneal Communication

Hemodialysis

Peritoneal Dialysis

Pleural Effusion