An uncommon cause of pleural effusions in a dialysis patient

Chapman, Fiona A; Blackmur, James P.; Fotheringham, James; Watson, Simon J.; Whitworth, Caroline; Dhaun, Neeraj

doi:10.1016/s0140-6736(12)60403-6

Cited by 2 publications

(3 citation statements)

References 2 publications

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“…Even pleural effusion due to heart failure is unique. Cases of isolated pleural effusion due to high-output heart failure as a result of a giant vascular access have been reported [9, 10]. Due to these common, unique, and important etiologies for this patient group, the prevalence and impact of malignant pleural effusion in HD patients may be less than that of the general population.…”

Section: Discussionmentioning

confidence: 99%

Primary Effusion Lymphoma in an Elderly HIV-Negative Patient with Hemodialysis: Importance of Evaluation for Pleural Effusion in Patients Receiving Hemodialysis

Sasaki¹,

Isegawa²,

Shimabukuro³

et al. 2014

Case Rep Nephrol Dial

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Pleural effusion is a ubiquitous complication in hemodialysis (HD) patients. Common etiologies of pleural effusion in this patient group are heart failure, volume overload, parapneumonic effusion, tuberculotic pleuritis, and uremic pleuritis. Although thoracentesis is a useful diagnostic method of pleural effusion, empirical reduction of the dry weight is often attempted without thoracentesis because pleural effusion is commonly caused by volume overload and responds to the dry-weight reduction. However, this empiricism has a risk of overlooking or delaying the diagnosis of potentially fatal etiologies that need specific treatments. We report an 86-year-old human immunodeficiency virus (HIV)-negative male on HD with primary effusion lymphoma (PEL), a large-cell non-Hodgkin lymphoma presenting with characteristic lymphomatous effusions in the absence of solid tumor masses, which is in association with human herpes virus 8 (HHV8) infection in immunocompromised individuals. The patient presented with left-sided pleural effusion. This is the first case report of PEL developing in a patient receiving HD. Thoracentesis and cytological analysis of the effusion was key to the diagnosis. We also review the literature regarding pleural effusion in HD patients. Further, we examine Kaposi's sarcoma herpes virus/HHV8-negative effusion-based lymphoma, a newly proposed distinct lymphoma that clinically and cytomorphologically resembles PEL, because it can be cured without chemotherapy. This report may arouse clinicians' attention regarding the importance of evaluation for pleural effusion in HD patients, especially when the effusion or symptoms associated with pleural effusion are refractory to volume control.

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Section: Discussionmentioning

confidence: 99%

Primary Effusion Lymphoma in an Elderly HIV-Negative Patient with Hemodialysis: Importance of Evaluation for Pleural Effusion in Patients Receiving Hemodialysis

Sasaki¹,

Isegawa²,

Shimabukuro³

et al. 2014

Case Rep Nephrol Dial

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“…Although in peritoneal dialysis many effusions are related to complications of the delivery of treatment or pleuroperitoneal communication, 2 in hemodialysis these arise because of a range of diseases that are more in keeping with the wider population and are predominantly transudates. 1,3 There are however a number of uncommon causes peculiar to this group of patients, including vascular access 4,5 and uremic pleuritis. 6 In the general population diagnostic thoracocentesis is advocated for moderate-sized effusions (>10 mm on ultrasonography), 7 which if bilateral and more likely to relate to an excess circulating volume, fail to respond to diuresis.…”

Section: Introductionmentioning

confidence: 99%

“…Although in peritoneal dialysis many effusions are related to complications of the delivery of treatment or pleuroperitoneal communication, in hemodialysis these arise because of a range of diseases that are more in keeping with the wider population and are predominantly transudates . There are however a number of uncommon causes peculiar to this group of patients, including vascular access and uremic pleuritis …”

Section: Introductionmentioning

confidence: 99%

Complication of diagnostic pleural aspiration: Is it of value in hemodialysis patients?

Corbett

Ashby

2014

Hemodialysis International

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Pleural effusions are common in hemodialysis patients and are associated with significant morbidity. Diagnostic pleural aspiration and subsequent biochemical analysis can be used to differentiate exudates and transudates. In particular, Light's criteria have been validated in the general population although their efficacy in hemodialysis patients is unclear. Furthermore, aspiration is not without risk; we report the case of a life-threatening thoracic bleed as a complication of diagnostic thoracocentesis in a hemodialysis patient, in whom a transudative effusion was misclassified according to Light's criteria. Retrospective examination of a further 22 aspirations in hemodialysis patients suggests that biochemical analysis of pleural fluid in this group is of limited value. Careful clinical and radiological assessment may be of greater value in determining individuals who may benefit from formal drainage, rather than diagnostic aspiration with its attendant risks.

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An uncommon cause of pleural effusions in a dialysis patient

Cited by 2 publications

References 2 publications

Primary Effusion Lymphoma in an Elderly HIV-Negative Patient with Hemodialysis: Importance of Evaluation for Pleural Effusion in Patients Receiving Hemodialysis

Primary Effusion Lymphoma in an Elderly HIV-Negative Patient with Hemodialysis: Importance of Evaluation for Pleural Effusion in Patients Receiving Hemodialysis

Complication of diagnostic pleural aspiration: Is it of value in hemodialysis patients?

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