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.
GagnonR.F., DanielsE.The persisting pneumatoenteric recess and the infracardiac bursa: possible role in the pathogenesis of right hydrothorax complicating peritoneal dialysis.Adv Perit Dial2004; 20: 132–6.
2.
EdwardsS.R., UngerA.M.Acute hydrothorax—a new complication of peritoneal dialysis.JAMA1967; 199: 853–5.
3.
KawaguchiA.L., DunnJ.C., FonkalsrudE.W.Management of peritoneal dialysis-induced hydrothorax in children.Am Surg1996; 62: 820–4.
4.
SzetoC.C., ChowK.M.Pathogenesis and management of hydrothorax complicating peritoneal dialysis.Curr Opin Pulm Med2004; 10: 315–19.
5.
NomotoY., SugaT., NakajimaK., SakaiH., OsawaG., OtaK.Acute hydrothorax in continuous ambulatory peritoneal dialysis—a collaborative study of 161 centers.Am J Nephrol1989; 9: 363–7.
Van DijkC.M., LedesmaS.G., TeitelbaumI.Patient characteristics associated with defects of the peritoneal cavity boundary.Perit Dial Int2005; 25: 367–73.
NassbergerL.Left-sided pleural effusion secondary to continuous ambulatory peritoneal dialysis.Acta Med Scand1982; 211: 219–20.
17.
TsunezukaY., HatakeyamaS., IwaseT., WatanabeG.Videoassisted thoracoscopic treatment for pleuroperitoneal communication in peritoneal dialysis.Eur J Cardiothorac Surg2001; 20: 205–7.
18.
OhtaniY., OhtaniO., NakataniT.Microanatomy of the rat diaphragm with special reference to the lymphatics and mesothelial stomata.Ital J Anat Embryol1995; 100(Suppl 1): 143–53.
ChoH.Y., LeeB.S., KangC.H., KimW.H., HaI.S., CheongH.I.Hydrothorax in a patient with Denys-Drash syndrome associated with a diaphragmatic defect.Pediatr Nephrol2006; 21: 1909–12.
25.
KrishnanM., ChoiM.A case of uremia-associated pleural effusion in a peritoneal dialysis patient.Semin Dial2001; 14: 223–7.
ChowC.C., SungJ.Y., CheungC.K., Hamilton-WoodC., LaiK.N.Massive hydrothorax in continuous ambulatory peritoneal dialysis: diagnosis, management and review of the literature.N Z Med J1988; 101: 475–7.
29.
HuangJ.J., WuJ.S., ChiW.C., LanR.R., YangL.F., ChiuN.T.Hydrothorax in continuous ambulatory peritoneal dialysis: therapeutic implications of Tc-99m MAA peritoneal scintigraphy.Nephrol Dial Transplant1999; 14: 992–7.
30.
SpadaroJ.J., ThakurV., NolphK.D.Technetium-99m-labelled macroaggregated albumin in demonstration of trans-diaphragmatic leakage of dialysate in peritoneal dialysis.Am J Nephrol1982; 2: 36–8.
31.
CanivetE., LavaudS., WampachH., WuillaiA., RandouxC., LiehnJ.C.Detection of subclinical abdominal hernia by peritoneal scintigraphy.Adv Perit Dial2000; 16: 104–7.
32.
GibbonsG.D., BaumertJ.Unilateral hydrothorax complicating peritoneal dialysis. Use of radionuclide imaging.Clin Nucl Med1983; 8: 83–4.
33.
AdamW.R., ArklesL.B., GillG., MeagherE.J., ThomasG.W.Hydrothorax with peritoneal dialysis: radionuclide detection of a pleuro-peritoneal connection.Aust N Z J Med1980; 10: 330–2.
34.
OtsukaN., KawaiS., FukunagaM., OnoS., MoritaK., NagaiK.Confirmation of dialysate leakage by intraperitoneal administration of radioactive colloid.Radiat Med1992; 10: 253–5.
35.
RajnishA., AhmadM., KumarP.Peritoneal scintigraphy in the diagnosis of complications associated with continuous ambulatory peritoneal dialysis.Clin Nucl Med2003; 28: 70–1.
36.
ChowK.M., SzetoC.C., WongT.Y., LiP.K.Hydrothorax complicating peritoneal dialysis: diagnostic value of glucose concentration in pleural fluid aspirate.Perit Dial Int2002; 22: 525–8.
TangS., ChuiW.H., TangA.W., LiF.K., ChauW.S., HoY.W.Video-assisted thoracoscopic talc pleurodesis is effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis.Nephrol Dial Transplant2003; 18: 804–8.
39.
MaciaM., GallegoE., Garcia-CobaledaI., ChahinJ., GarciaJ.Methylene blue as a cause of chemical peritonitis in a patient on peritoneal dialysis.Clin Nephrol1995; 43: 136–7.
Di BisceglieM., PaladiniP., VoltoliniL., GarosiG., GhiribelliC., Di PaoloN.Videothoracoscopic obliteration of pleuroperitoneal fistula in continuous peritoneal dialysis.Ann Thorac Surg1996; 62: 1509–10.
42.
HalsteadJ.C., LimE., RitchieA.J.Acute hydrothorax in CAPD. Early thoracoscopic (VATS) intervention allows return to peritoneal dialysis.Nephron2002; 92: 725–7.
LangC.L., KaoT.W., LeeC.M., TsaiC.W., WuM.S.Video-assisted thoracoscopic surgery in continuous ambulatory peritoneal dialysis-related hydrothorax.Kidney Int2008; 74: 136.
45.
Girault-LatasteA., AbazaM., ValentinJ.F.Small volume APD as alternative treatment for peritoneal leaks.Perit Dial Int2004; 24: 294–6.
46.
ChristidouF., VayonasG.Recurrent acute hydrothorax in a CAPD patient: successful management with small volumes of dialysate [Letter].Perit Dial Int1995; 15: 389.
47.
StraussF.G., HolmesD.L., DennisR.L., NortmanD.F.Shortdwell peritoneal dialysis: increased use and impact on clinical outcome.Adv Perit Dial1993; 9: 49–51.
48.
TownsendR., FragolaJ.A.Hydrothorax in a patient receiving continuous ambulatory peritoneal dialysis: successful treatment with intermittent peritoneal dialysis.Arch Intern Med1982; 142: 1571–2.
49.
IngA., RutlandJ., KalowskiS.Spontaneous resolution of hydrothorax in continuous ambulatory peritoneal dialysis.Nephron1992; 61: 247–8.
50.
BjerkeH.S., AdkinsE.S., FogliaR.P.Surgical correction of hydrothorax from diaphragmatic eventration in children on peritoneal dialysis.Surgery1991; 109: 550–4.
KanaanN., PietersT., JamarF., GoffinE.Hydrothorax complicating continuous ambulatory peritoneal dialysis: successful management with talc pleurodesis under thoracoscopy.Nephrol Dial Transplant1999; 14: 1590–2.
54.
JagasiaM.H., ColeF.H., StegmanM.H., DeatonP., KennedyL.Video-assisted talc pleurodesis in the management of pleural effusion secondary to continuous ambulatory peritoneal dialysis: a report of three cases.Am J Kidney Dis1996; 28: 772–4.
55.
OkadaH., RyuzakiM., KotakiS., NakamotoH., SugaharaS., KanekoK.Thoracoscopic surgery and pleurodesis for pleuroperitoneal communication in patients on continuous ambulatory peritoneal dialysis.Am J Kidney Dis1999; 34: 170–2.
56.
HosodaH., NishioY., FujisakiH., SunamoriM.[Videoscopic surgical treatment for the patient of pleuroperitoneal communication complicating CAPD] [Japanese].Kyobu Geka2000; 53: 251–3.
57.
KumagaiH., WatariM., KuratsuneM.Simple surgical treatment for pleuroperitoneal communication without interruption of continuous ambulatory peritoneal dialysis.Gen Thorac Cardiovasc Surg2007; 55: 508–11.
58.
MorenoA., SuriaS., Perez-ValentinM.A., ToledoA., EsparzaN., Garcia-CantonC.Hydrothorax in peritoneal dialysis. Effective treatment with pleurodesis.Perit Dial Int1998; 18: 657–8.
59.
BenzR.L., SchleiferC.R.Hydrothorax in continuous ambulatory peritoneal dialysis: successful treatment with intrapleural tetracycline and a review of the literature.Am J Kidney Dis1985; 5: 136–40.
60.
GreenA., LoganM., MedawarW., McGrathF., KeelingF., CarmodyM.The management of hydrothorax in continuous ambulatory peritoneal dialysis (CAPD).Perit Dial Int1990; 10: 271–4.
61.
BakkalogluS.A., EkimM., TumerN., GungorA., YilmazS.Pleurodesis treatment with tetracycline in peritoneal dialysis-complicated hydrothorax.Pediatr Nephrol1999; 13: 637–8.
62.
CatizoneL., ZuchelliA., ZucchelliP.Hydrothorax in a PD patient: successful treatment with intrapleural autologous blood instillation.Adv Perit Dial1991; 7: 86–90.
63.
HidaiH., TakatsuS., ChibaT.Intrathoracic instillation of autologous blood in treating massive hydrothorax following CAPD.Perit Dial Int1989; 9: 221–3.
64.
OkadaK., TakahashiS., KinoshitaY.Effect of pleurodesis with autoblood on hydrothorax due to continuous ambulatory peritoneal dialysis-induced diaphragmatic communication.Nephron1993; 65: 163–4.
65.
ScarpioniR.Acute hydrothorax in a peritoneal dialysis patient: long-term efficacy of autologous blood cell pleurodesis associated with small-volume peritoneal exchanges.Nephrol Dial Transplant2003; 18: 2200–1; author reply: 2201.
66.
ChaoS.H., TsaiT.J.Recurrent hydrothorax following repeated pleurodesis using autologous blood.Perit Dial Int1993; 13: 321–2.
67.
ArizaM., LopezM., QuesadaT.Complications of CAPD in children: six years experience in Caracas, Venezuela.Adv Perit Dial1991; 7: 269–71.
68.
MakS.K., NyuntK., WongP.N., LoK.Y., TongG.M., TaiY.P.Long-term follow-up of thoracoscopic pleurodesis for hydrothorax complicating peritoneal dialysis.Ann Thorac Surg2002; 74: 218–21.
69.
UeshimaY., HamashimaT., IkedaE., IwamotoN., ShioakiY., MutouF.[Thoracoscopic repair of diaphragmatic thinning for pleuroperitoneal communication: report of a case] [Japanese].Kyobu Geka2004; 57: 984–6.
