Image Analysis

Image 1: Chest radiography, AP incidence, showing hyperinflated lungs.

 

 

 

Images 2 and 3: Chest radiographies in AP and lateral view after peritoneal dialysis: medial displacement of right visceral pleura and compression of the ipsilateral lung conditioned by pleural effusion (red arrows).

 

 

Image 4: Peritoneal/pleural fistula in 99mTc - MAA (macroaggregated albumin labeled with metastable technetium 99m), infused into the peritoneal dialysis fluid demonstrated by the presence of the material in the right hemithorax.

Highlights

- The pleural effusion that results from peritoneal/pleural fistula is a rare complication of continuous ambulatory peritoneal dialysis (CAPD).
- About 25% of the patients are asymptomatic. When symptomatic, they may show only dry cough and dyspnea.
- There is no consensus on which diagnostic method has better accuracy, but scintigraphy using 99mTc-MAA infusion into the peritoneal dialysis fluid has been a fast and appropriate examination to diagnose peritoneal origin of the pleural fluid.
- Therapeutic approaches include suspension of peritoneal dialysis, at least temporarily, and surgical treatment in cases of relapse.
- Currently, talc pleurodesis is the surgical approach of first choice.

References

- Rajnish, Anshu, Muffazal Ahmad, and Pradeep Kumar. "Peritoneal scintigraphy in the diagnosis of complications associated with continuous ambulatory peritoneal dialysis." Clinical nuclear medicine 28.1 (2003): 70-71.

- Szeto, Cheuk Chun, and Kai Ming Chow. "Pathogenesis and management of hydrothorax complicating peritoneal dialysis." Current opinion in pulmonary medicine 10.4 (2004): 315-319.

- Maude, Rapeephan R., and Michael Barretti. "Severe “sweet” pleural effusion in a continuous ambulatory peritoneal dialysis patient." Respiratory Medicine Case Reports 13 (2014): 1-3.

- Herbrig, Kay, et al. "Dry cough in a CAPD patient." Nephrology Dialysis Transplantation 18.5 (2003): 1027-1029.

- Chavannes, M., et al. "Diagnosis by Peritoneal Scintigraphy of Peritoneal Dialysis-Associated Hydrothorax in an Infant." Peritoneal Dialysis International 34.1 (2014): 140-143.

- Daugirdas, John T., Peter G. Blake, and Todd S. Ing. Manual de diálise. Medsi, 2003.

Authors

Caroline dos Reis, 6th year medical student at UFMG.

E-mail: creis.caroline[arroba]gmail.com

 

Bárbara Queiroz Bragaglia, 6th year medical student at UFMG.

E-mail: barbara.bragaglia[arroba]hotmail.com

 

Gustavo Campos, 6th year medical student at UFMG.

E-mail: fcamposgustavo[arroba]gmail.com

Supervisor

Gláucia Santos, pediatric nephrologist of the Dialysis Service of HC-UFMG

E-mail: glauciaplacidonio[arroba]gmail.com

Reviewers

Júlia Petrocchi, Fernando Bottega, Ana Luiza Mattos Tavares, Luísa Bernardino, Professor Viviane Parisotto e Professor José Nelson Mendes Vieira.

Translated by

Luísa Bernardino Valério, 4th year medical student at UFMG.

E-mail: luisabernardino[at]gmail.com