Journal Article

Right-sided hydrothorax: a peritoneal dialysis dilemma

Salzer, William, Hudhud, Dania, Allaham, Haytham

2018

Overview

We present a 23-year-old female patient with a chief complaint of progressively worsening dyspnoea of 2 days duration. Her medical history was significant for end stage renal disease secondary to membranoproliferative glomerulonephritis. A peritoneal dialysis (PD) catheter was placed 8 weeks prior to admission. She did not miss any of the PD sessions prior to this admission. Vital signs were significant for hypoxemia. Physical examination was remarkable for right-sided basilar crackles with no other signs of fluid overload. A chest X-ray demonstrated the presence of a large right-sided pleural effusion. Right-sided thoracentesis was performed, with subsequent pleural fluid analysis concerning for a pleuroperitoneal leak. CT peritoneography performed confirming the diagnosis as contrast material leaked through the inferior vena cava (IVC) diaphragmatic foramen into the right pleural space. Surgical intervention was deferred in light of the close proximity of the defect to the IVC. The patient was transitioned to haemodialysis for temporary cessation of PD.

• Publisher: BMJ Publishing Group Ltd,BMJ Publishing Group LTD,BMJ Publishing Group
• Subject: Case reports / Catheters / Defects / dialysis / Dyspnea / Family medical history / Female / fluid electrolyte and acid-base disturbances / Glucose / Hemodialysis / Humans / Hydrothorax - etiology / Hypoxemia / Kidney diseases / Kidney Failure, Chronic - therapy / Medical imaging / Patients / Peritoneal dialysis / Peritoneal Dialysis - adverse effects / Pleural effusion / Pleural Effusion - diagnostic imaging / Pleural Effusion - etiology / Rare Disease / renal system / respiratory medicine / Surgery / Thoracentesis / Young Adult