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Case Report

This is the case of a 63 y/o female patient, with a past medical history of adult polycystic kidney disease (ADPKD), hypertension, hypothyroidism, and hypercholesterolemia that was started on peritoneal dialysis one month ago. Patient presented to emergency department with shortness of breath and fatigue for the past 3 weeks that was getting worse, causing fatigue and orthopnea. Physical examination was remarkable for decreased breath sounds on the right side, no jugular venous distention, no peripheral edema, and patent peritoneal dialysis tunneled catheter in the abdomen. Portable chest x-ray reported diffuse right white lung with mass-effect towards the left. The Chest CT scan without IV contrast reported large right-sided pleural fluid collection with near total collapse of the lung and polycystic kidney disease. Due to large amount pleural fluid, surgery services were consulted for chest tube placement. The analysis result of the pleural fluid was consistent with transudate fluid and elevated glucose level (69 mg/dl). She had relief after chest tube drainage and no recurrence of pleural effusion occurred after patient was switched to hemodialysis. Findings suggest a pleuroperitoneal leak, due to given history of ADPKD with pleural effusion that occurs early after peritoneal dialysis initiation, and no other clinical findings of fluid overload.

Discussion

Pleuroperitoneal leak is a rare complication of peritoneal dialysis with an incidence of 1.6% to 10%, where women are more affected. This condition may occur due to communications between the pleura and the peritoneum. In addition, patients with ADPKD are predisposed to develop this non-infectious complication due to increased hydrostatic pressure. However, many occasions pleural effusion resolve with overnight dwells. Our patient required chest tube placement for resolution of symptoms, and she could not be a candidate to continue with peritoneal dialysis. Although, if patient were aware of her predisposition and seek medical attention earlier conservative measures could be implanted and patient may continue with her current mode of therapy. This case serves for remainder about the importance of educating patient about how to identify therapy complications.