Traumatic pleural leak in peritoneal dialysis

Hausmann, Michael; Basok, Anna; Vorobiov, Marina; Rogachev, V. Boris

doi:10.1093/ndt/16.7.1526

Cited by 10 publications

(6 citation statements)

References 4 publications

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“…Trauma frequently causes PD fluid to appear in the thorax (19). A sudden increase in intra-abdominal pressure opens a communication between the abdomen and the thorax, allowing PD fluid to leak into the thorax (19,20).…”

Section: Epidemiologymentioning

confidence: 99%

Hydrothorax: Pleural Effusion Associated with Peritoneal Dialysis

Lew

2010

Perit Dial Int

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Hydrothorax in a patient treated with peritoneal dialysis (PD) poses a diagnostic dilemma. Hydrothorax due to migration of dialysis fluid across the diaphragm and into the pleural space creates a serious complication of PD but generally does not threaten life. Shortness of breath causes the patient to seek medical attention. A sudden diminution in dialysis adequacy or poor ultrafiltration rate constitutes a unique marker for patients treated with PD compared to the general population. This article reviews the etiology for hydrothorax specifically in the PD population. Thoracentesis with chemical analysis of the fluid, imaging studies with and without contrast or markers, and video-assisted thoracoscopic surgery play important roles in the evaluation of hydrothorax. A conservative PD regimen, surgical intervention, and pleurodesis provide treatment options to those receiving PD.

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Section: Epidemiologymentioning

confidence: 99%

Hydrothorax: Pleural Effusion Associated with Peritoneal Dialysis

Lew

2010

Perit Dial Int

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“…[ 5 ] The exact mechanism by which peritoneal dialysate crosses the diaphragm is not known, possibly due to a pleuroperitoneal communication (congenital or acquired) and/or by lymphatic transport along the aorta or thoracic duct. [ 6 7 ] Congenital defects (i.e., pneumatoenteric recess, infracardiac bursa) explain the preponderance of right-sided hydrothorax because left-sided defects are covered by the heart and pericardium, thereby reducing the possibility of a leak on the left side. In addition, abnormalities in subpleural lymphatic structures predominate in the right hemidiaphragm.…”

Section: Discussionmentioning

confidence: 99%

Modalities of diagnosis and management of peritoneal dialysis-related hydrothorax including videothoracoscopy-assisted repair: A single-center experience

Prasad¹,

Patel²,

Kushwaha³

et al. 2021

Indian J Nephrol

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Continuous ambulatory peritoneal dialysis (PD)-related hydrothorax (PDRH) is uncommon; however, it is associated with a high discontinuation rate and morbidity. We report clinical characteristics, pleural fluid chemistry patterns, diagnostic modality, management options, and outcomes in 12 patients who have confirmed pleuroperitoneal communication after the inception of the PD program at our institute. The incidence of PDRH in our study was 0.64%. The interval between initiation of PD and hydrothorax ranged from 7 weeks to 40 weeks (average 20.6 weeks). Ten (83.3%) had right-sided, one (8.3%) left-sided, and one (8.3%) bilateral hydrothorax. Most patients (83.3%) had dyspnea with chest symptoms, but two (16.6%) patients were asymptomatic. All patients had confirmed communication either by peritoneal scintigraphy or computed topography peritoneography. PD had to be stopped in two patients and patients were shifted back to hemodialysis. Pleurodesis, through thoracostomy with tetracycline or betadine, was used for four patients. Three patients underwent video-assisted thoracoscopy (VATS) with surgical repair of the diaphragmatic defect, and one underwent VATS assisted talc pleurodesis. All four patients who underwent VATS repair of the defect had successful outcomes. With availability and experience with VATS, most patients had successfully returned to PD with no recurrence and with minimal morbidity.

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“…Clinical symptoms of pleural effusions include sudden dyspnea, decrease in ultrafiltration rate, and pleuritic chest pain. One study reported that approximately 25% of patients are asymptomatic [4]. In patients with recurrent unilateral pleural effusions or acute respiratory distress after dialysate infusion, trans-diaphragmatic leakage or peritoneal fistulae should be considered.…”

Section: Discussionmentioning

confidence: 99%

Untitled

2018

JCMAH

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Traumatic pleural leak in peritoneal dialysis

Cited by 10 publications

References 4 publications

Hydrothorax: Pleural Effusion Associated with Peritoneal Dialysis

Hydrothorax: Pleural Effusion Associated with Peritoneal Dialysis

Modalities of diagnosis and management of peritoneal dialysis-related hydrothorax including videothoracoscopy-assisted repair: A single-center experience

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