A Rare Complication in a Peritoneal Dialysis Patient: Hydrothorax in Late Period

Hydrothorax in Peritoneal Dialysis

Abstract

Peritoneal dialysis (PD) associated hydrothorax is a rare complication caused by leakage of dialysis fluid from the peritoneal cavity into the pleural space. The typical clinical presentation is a right-sided pleural effusion and patients present with sudden chest pain, shortness of breath, and loss of ultrafiltration. The fluid is usually transudate. Chow gradient [pleural fluid glucose concentration - serum glucose concentration] > 50 mg/dL supports the diagnosis. It usually occurs in the first few months after the onset of PD in cases with congenital diaphragmatic defects or lymphatic drainage disorders. In patients with clinical conditions that increase the pleuroperitoneal pressure difference, such as constipation, may also occur in later periods, as in the case we presented. A 53-year-old male patient presented with chest pain and shortness of breath in the 10th month of PD treatment. A diagnosis of “PD-associated hydrothorax” was made with transudative pleural effusion in the right hemithorax and high a Chow gradient. In this case, increased pleuro-peritoneal pressure difference due to constipation that has been going on for several weeks was evaluated in favor of a late hydrothorax clinic.