Abstract: PUB204
Effusion Confusion: The Tale of a Pleuro-Peritoneal Fistula
Session Information
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Murphy, Fiona, Mayo Clinic Minnesota, Rochester, United States
- Harris, Luke, University of Galway, Galway, Ireland
- Salonen, Bradley R., Mayo Clinic Minnesota, Rochester, Minnesota, United States
Introduction
Pleural effusions are common in patients on peritoneal dialysis (PD). A pleuroperitoneal fistula (PPF) is an important cause. Delays in diagnosis can lead to worsening of pleural effusions, particularly if a mistaken suspicion of fluid overload leads to the escalating use of high osmolar peritoneal dialysate fluids and volumes with the aim to achieve better ultrafiltration.
Case Description
A 78-year-old female presented with 10 days of dyspnoea. She had autosomal dominant polycystic kidney disease (PCKD) on PD. She was commenced on PD 12 weeks prior. She has right sided stage IIIA lung cancer in remission.
On examination she was tachypneic, with absent breath sounds on the right and volume overloaded. Blood workup was unremarkable. Chest X-ray (CXR) showed a right pleural effusion. Pleural tap was performed. She was diagnosed with a PPF, given that pleural glucose was significantly higher than serum, in addition to her unilateral effusion.(Table 1) A dialysis catheter was placed and she transitioned to hemodialysis.
Discussion
In a patient undergoing peritoneal dialysis with a unilateral pleural effusion, special consideration must be given to a possible PPF. The estimated incidence is less than 2%. A risk factor for PPF is PCKD. PCKD leads to high intra-abdominal pressure could lead to an increased pleuroperitoneal pressure gradient. For diagnostics a pleural glucose concentration higher than serum is highly suggestive of a PPF. The long-term management of a PPF depends on its severity and patient preference.
Pleural Fluid Analysis
| Serum | Pleural | |
| pH | 7.4 | 7.52 |
| Glucose mg/dL | 82 | 231 |
| LDH U/L | 160 | 31 |
| Protein g/dL | 67 | 0.3 |
Admission CXR