Kidney Week

Abstract: PUB209

Pleuroperitoneal Communication: A Rare Complication of Peritoneal Dialysis Observed in an Ecuadorian Hospital

Session Information

• Publication Only

Category: Dialysis

• 802 Dialysis: Home Dialysis and Peritoneal Dialysis

Authors

• Valdivieso, Jorge Andres, Universidad de Las Americas Facultad de Ciencias de la Salud, Quito, Pichincha, Ecuador

Jorge Andres Valdivieso, MD

• Penafiel, Wilson Sebastian, Universidad de Las Americas Facultad de Ciencias de la Salud, Quito, Pichincha, Ecuador

Wilson Sebastian Penafiel, MD

• Monge, Andrés Ricardo, Universidad de Las Americas Facultad de Ciencias de la Salud, Quito, Pichincha, Ecuador

Andrés Ricardo Monge, MD

• Dirani, Michella, Universidad San Francisco de Quito, Quito, Pichincha, Ecuador

Michella Dirani

• Anstead, Michael I., University of Kentucky, Lexington, Kentucky, United States

Michael I. Anstead, MD

• Coronel, Carina Vanessa, Universidad Central del Ecuador, Quito, Pichincha, Ecuador

Carina Vanessa Coronel, MD

• Fernandez, Monica Graciela, Universidad Central del Ecuador, Quito, Pichincha, Ecuador

Monica Graciela Fernandez, MD

Introduction

Pleuroperitoneal communication (PPC) is a rare complication seen in approximately 1.6% of patients with end-stage renal disease who undergo peritoneal dialysis. Although there have been several reports where its diagnosis and management have followed a straightforward path, we encounter a case in which the accessibility to some of the diagnostic tools has become a limitation for its final treatment. The gold standard for diagnosis is Tc-99m scintigraphy, which is noninvasive, low in radiation, simple, safe, and cost-effective. The treatment of choice is video-assisted thoracic surgery (VATS).

Case Description

A 65-year-old male with a history of end-stage renal disease treated with peritoneal dialysis presented to the emergency department with a productive cough, fever, inferior limb edema, and dyspnea. A Computed Tomography (CT) Scan revealed a right unilateral pleural effusion. A cytology analysis of the pleural fluid showed an elevated glucose concentration. TC-99m scintigraphy was not available to confirm the diagnosis. The ultimate decision was to discontinue peritoneal dialysis and initiate hemodialysis instead. One month after follow-up the patient did not reveal any signs of hydrothorax.

Discussion

PPC represents a rare complication in patients undergoing peritoneal dialysis. While TC-99m scintigraphy and VATS are the gold standards for diagnosing and treating this condition, their advanced and complex nature renders them unavailable at every healthcare center. Consequently, alternative treatment strategies, such as discontinuing peritoneal dialysis and transitioning to hemodialysis, may need to be considered, despite potential compromises to patient well-being.

Chest CT. Coronal view shows right hydrothorax.