Abstract: FR-PO478
The Fastest Way to a Person's Heart: A Case of Peritoneal-Pericardial Leak after Pericardiocentesis in a Patient on Peritoneal Dialysis
Session Information
- Home Dialysis - 1
October 25, 2024 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 802 Dialysis: Home Dialysis and Peritoneal Dialysis
Authors
- Siddiqui, Neha, Baylor College of Medicine, Houston, Texas, United States
- Winkelmayer, Wolfgang C., Baylor College of Medicine, Houston, Texas, United States
- Kassem, Hania, Baylor College of Medicine, Houston, Texas, United States
Introduction
While peritoneal dialysis (PD) is a cost effective dialysis modality, it is associated with infectious and non-infectious complications including PD fluid leaks. Leakage of dialysate into the pericardium is an uncommon yet potentially life-threatening complication of PD. To our knowledge, there are very few cases of peritoneal-pericardial leaks reported in the literature.
Case Description
A 55-year-old Hispanic female with a past medical history of CKD stage V secondary to DM and HTN (biopsy proven), presented to the emergency department with shortness of breath and was found to have a pericardial effusion with early tamponade physiology. Patient underwent successful pericardiocentesis via a sub-xyphoid approach with removal of 500cc of serous fluid and was discharged on diuretics.
She was readmitted shortly afterwards for shortness of breath, was found to have worsening pleural effusions requiring chest tubes placement, and was initiated on PD urgently during that admission.
Patient was admitted again a few days later with similar complaints and was found to have another pericardial effusion. PD was continued during that admission with no improvement in breathing despite multiple changes in the prescription. CXR showed complete opacification of the right lung. Therefore, a CT peritoneography was obtained to rule out pleuroperitoneal communication but showed instead direct communication between the peritoneal dialysate and a large pericardial effusion. Decision was made to discontinue PD and to initiate hemodialysis resulting in improvement in symptoms.
Discussion
Similarly to previous reports, the peritoneal-pericardial communication in this patient likely resulted from pericardiocentesis. The procedure has been reported to cause communications between the pericardium and the pleural and peritoneal space. However, communication with the peritoneum is unlikely to be recognized or be clinically significant except in PD patients due to the possibility of peritoneal fluid leaking into the pericardium. This represents a rare yet critical complication of PD, posing a significant threat to life. Physicians should be mindful of peritoneopericardial fistulas as a possible complication in PD patients who undergo pericardiocentesis since a timely diagnosis is crucial to promptly discontinue PD and mitigate further risks.