Pleuroperitoneal communication on peritoneal dialysis patients - presentation of four cases

• Autor(a) principal: Martins,Ana Rita
• Data de Publicação: 2015
• Outros Autores: Branco,Patrícia, Gonçalves,Margarida, Marques,Marta, Afonso,Sophia P, Gaspar,Augusta, Barata,José Diogo
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692015000200010
• topic: Continuous ambulatory peritoneal dialysis; peritoneopleural communication; pleurodesis; secondary hydrothorax; technetium-99m-macroaggregated albumin scintigraphy (99mTc-MAA)

Peritoneal dialysis is an established treatment option for patients with end-stage renal disease. As this procedure causes high pressure in the abdomen, it might lead to peritoneopleural leakage (hydrothorax). The latter is an uncommon non-infectious complication of peritoneal dialysis patients, possibly secondary to trans-diaphragmatic fluid leakage through a pleuroperitoneal communication. The aetiology of this condition is still unclear. A variety of mechanisms have been proposed: congenital diaphragmatic defects; pleuroperitoneal pressure gradient; lymph drainage disorder; acquired diaphragmatic defects that are a consequence of increased intra-abdominal pressure during the dwell period of peritoneal dialysis, such as fenestrations or acquired scarcity of muscle fibres in the tendinous part of the diaphragm. Peritoneal scintigraphy (99mTc-MAA peritoneoscintigraphy) is a useful diagnostic tool in the management of suspected pleuroperitoneal communication. We report four cases of hydrothorax related to pleuroperitoneal communication in 290 patients treated with chronic peritoneal dialysis, between 1999 and 2014, at our PD Unit. Here we analyse our department’s incidence of this complication and also present own experience in diagnosing and treating it.