Peritoneal-Pleural Leaks Demonstrated by CT Peritoneography

INTRODUCTION: Acute hydrothorax is an uncommon complication of peritoneal dialysis (PD). Currently, there is no specific diagnostic method. Although it is not a life-threatening complication, hydrothorax often requires interrupting or quitting PD. Misdiagnosis often leads to more serious consequences. CASE PRESENTATION: A 49-year-old woman (height 163 cm, weight 58 kg, BMI 21.82), who started PD 3 months previously, suddenly presented with acute dyspnea and a right pleural effusion. Blood routine examination, serum albumin and a series of laboratory tests were immediately performed. Except for the serum creatinine, all of the other tests were within normal range. Thoracentesis was performed to obtain pleural fluid specimens; there was also no evidence of a tumor or inflammation. Congestive heart failure, infection and hypoalbuminemia were excluded as well. Because PD-associated pleural leakage was suspected, computerized tomography (CT) peritoneography was performed next. The first CT scan showed that the CT value of pleural effusion was 6 Hounsfield units (HU). On the evening of the same day, 100 ml ionic contrast medium was mixed with 2 l dialysate and infused into the peritoneal cavity. The next morning, a CT scan was performed again. The CT value of pleural effusion at the same site increased to 40 HU. At the end, pleural leakage was clearly diagnosed. Subsequently, she received temporary hemodialysis and a small dose of automated PD. After 3 months, she successfully returned to PD without any recurrence of hydrothorax. CONCLUSION: Although similar case reports are not rare, this report provided a simple and effective method for diagnosing pleural leakage. Furthermore, noninvasive treatment of pleural effusion will also get a satisfactory outcome.