Recurrent hydrothorax in a child on peritoneal dialysis: A case report and review of the literature

Alhasan, Khalid

doi:10.1002/ccr3.1936

Cited by 6 publications

(7 citation statements)

References 9 publications

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“…The first case of a pleuroperitoneal leak was described by Edwards and Unger in 1967 [ 3 ]. Patients often present with acute dyspnea, cough, or pleuritic chest pain [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

“…There are multiple predisposing mechanisms for pleuroperitoneal leaks including diaphragmatic muscular hypotonia, congenital diaphragmatic defects, pleuroperitoneal pressure gradients, and lymphatic drainage disorders [ 4 ]. A known risk factor for a pleuroperitoneal leak is polycystic kidney disease, where the high intra-abdominal pressure could lead to an increased pleuroperitoneal pressure gradient.…”

Section: Discussionmentioning

confidence: 99%

“…Both ultrasound and X-ray can confirm the presence of effusion, but not the source of the fluid. Peritoneal scintigraphy is considered an excellent modality to diagnose a pleuroperitoneal leak, but the sensitivity has been reported to be only 40% to 50%, and its utility in locating the site of the pleuroperitoneal communication is limited [ 4 , 7 , 9 ]. In a case report, Kang and Kim suggested that CT peritoneography with intraperitoneal contrast could confirm and locate the pleuroperitoneal fistula [ 10 ].…”

Section: Discussionmentioning

confidence: 99%

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Pleuroperitoneal Leak as an Uncommon Cause of Pleural Effusion in Peritoneal Dialysis: A Case Report and Literature Review

Dang

Mathew

Rajesh

2020

Case Reports in Nephrology

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Pleural effusions are frequently seen in patients on dialysis. A pleuroperitoneal leak or communication is a rare but important cause of pleural effusion in patients on peritoneal dialysis. This diagnosis can be made with a combination of biochemical tests and radiological modalities, in the absence of a gold standard diagnostic test. In addition to thoracocentesis, treatment often involves cessation of peritoneal dialysis and transition to hemodialysis. We describe a case of an 80-year-old man who presented with unilateral right-sided pleural effusion. He underwent therapeutic thoracocentesis and was subsequently diagnosed with a pleuroperitoneal leak through pleural fluid analysis. Peritoneal dialysis was ceased, and he transitioned temporarily to hemodialysis. He was subsequently treated with talc pleurodesis and successfully recommenced on peritoneal dialysis at six weeks after operation. In our report, we also review diagnostic imaging modalities, as well as advantages and disadvantages of each modality. A pleuroperitoneal leak is a rare but important complication of peritoneal dialysis and needs consideration in any patient on peritoneal dialysis presenting with unilateral pleural effusion.

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“…The first case of a pleuroperitoneal leak was described by Edwards and Unger in 1967 [ 3 ]. Patients often present with acute dyspnea, cough, or pleuritic chest pain [ 4 ].…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Pleuroperitoneal Leak as an Uncommon Cause of Pleural Effusion in Peritoneal Dialysis: A Case Report and Literature Review

Dang

Mathew

Rajesh

2020

Case Reports in Nephrology

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“…[ 30 ] CT peritoneography is useful in cases of large pleuroperitoneal communication; however, it is not sensitive in detecting smaller defects. [ 31 ] It is associated with a 33% sensitivity for detection for pleuroperitoneal leaks. [ 32 ]…”

Section: Discussionmentioning

confidence: 99%

Scintigraphic peritoneography in the diagnosis of pleuroperitoneal leak complicating peritoneal dialysis

Harry¹,

Nyakale²,

Tinarwo

2020

Medicine

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A pleuroperitoneal leak (PPL) is a relatively rare complication of peritoneal dialysis (PD) and early diagnosis is essential. Patients suspected of a PPL usually present with dyspnea (marked during inflow of PD fluid) and tend to have transudative high glucose pleural effusions. The PPL scintigraphy (PPLS) is one of the methods for objectively proving a PPL. The effectiveness of PPLS as a noninvasive method of evaluating a suspected PPL and its effectiveness in the exclusion of a leak in patients with similarly presenting comorbidities was assessed. Patients suspected to have a PPL were considered for PPLS based on clinical presentation and pleural fluid analysis. Radiopharmaceutical was administered into the peritoneum via the dialysis port with the patient lying supine and immediate dynamic followed by delayed statics were acquired. Of the 27 scans reviewed, 70% were found to be positive with majority detected within 12 minutes of radiopharmaceutical administration with a high predominance occurring in the right chest ( P < .001). In PPLS-positive patients, when both chest X-rays and planar agreed on showing the right-sided chest predominance, the highest measurements of the pleural glucose:serum glucose ratio were recorded. A statistically significant correlation between the outcome of the scan and final decision on patient management was noted ( P < .01). The PPLS is an effective diagnostic tool for assessing PPLS. However, multicenter studies investigating its added value over other conventional methods are needed to establish it as a highly relevant diagnostic tool.

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“…Such conditions might be associated with very large pleural effusion and/or ascites when lymphatic structures might become overdistended, impeding the valve leaflets to efficiently close and thus, compromising the whole diaphragmatic lymphatic function. These considerations might explain the clinically relevant pleural effusions observed in patients undergoing peritoneal dialysis [ 80 , 81 , 82 , 83 , 84 , 85 , 86 , 87 ]. In these cases, diaphragmatic lymphatics likely lose their ability to sustain subatmospheric pressures in their lumen and the transdiaphragmatic pleuro-peritoneal pressure gradient becomes prevailing in driving fluid and solute fluxes.…”

Section: Role Of Diaphragmatic Lymphatic In Pleural-peritoneal Draina...mentioning

confidence: 99%

Morphological, Mechanical and Hydrodynamic Aspects of Diaphragmatic Lymphatics

Negrini

2022

Biology

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The diaphragmatic lymphatic vascular network has unique anatomical characteristics. Studying the morphology and distribution of the lymphatic network in the mouse diaphragm by fluorescence-immunohistochemistry using LYVE-1 (a lymphatic endothelial marker) revealed LYVE1+ structures on both sides of the diaphragm—both in its the muscular and tendinous portion, but with different vessel density and configurations. On the pleural side, most LYVE1+ configurations are vessel-like with scanty stomata, while the peritoneal side is characterized by abundant LYVE1+ flattened lacy-ladder shaped structures with several stomata-like pores, particularly in the muscular portion. Such a complex, three-dimensional organization is enriched, at the peripheral rim of the muscular diaphragm, with spontaneously contracting lymphatic vessel segments able to prompt contractile waves to adjacent collecting lymphatics. This review aims at describing how the external tissue forces developing in the diaphragm, along with cyclic cardiogenic and respiratory swings, interplay with the spontaneous contraction of lymphatic vessel segments at the peripheral diaphragmatic rim to simultaneously set and modulate lymph flow from the pleural and peritoneal cavities. These details may provide useful in understanding the role of diaphragmatic lymphatics not only in physiological but, more so, in pathophysiological circumstances such as in dialysis, metastasis or infection.

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Recurrent hydrothorax in a child on peritoneal dialysis: A case report and review of the literature

Cited by 6 publications

References 9 publications

Pleuroperitoneal Leak as an Uncommon Cause of Pleural Effusion in Peritoneal Dialysis: A Case Report and Literature Review

Pleuroperitoneal Leak as an Uncommon Cause of Pleural Effusion in Peritoneal Dialysis: A Case Report and Literature Review

Scintigraphic peritoneography in the diagnosis of pleuroperitoneal leak complicating peritoneal dialysis

Morphological, Mechanical and Hydrodynamic Aspects of Diaphragmatic Lymphatics

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