A Case of Hydrothorax Aggravated by Peritoneal Dialysate Leakage in Compensated Liver Cirrhosis Patient with Ascites

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Kosin Med J. 2014;29(1):53-57

Publication date (electronic) : 2014 December 17

doi : https://doi.org/10.7180/kmj.2014.29.1.53

Gain You , Ho Sik Shin , Yeon Soon Jung , Hark Rim

Department of Internal Medicine, College of Medicine, Kosin University, Busan, Korea

Corresponding Author: Ho Sik Shin, Deparment of Internal Medicine, College of Medicine, Kosin University, 34 Amnamdong, Seo-gu, Busan, 602-702, Korea TEL: +82-51-990-6108 FAX: +82-51-248-5686 E-mail: danieljoseph@hanmail.net

Received 2012 January 16; Revised 2012 June 04; Accepted 2012 July 04.

Abstract

The cirrhotic patients with ascites present unique challenge to the renal caregiver. Hydrothorax in a cirrhotic patient treated with PD poses a diagnostic dilemma. Proposed mechanisms for the development of a pleuroperitoneal communication include congenital diaphragmatic defects, acquired weakening of diaphragmatic fibers caused by high intra-abdominal pressures during peritoneal dialysis, and impairments in lymphatic drainage. Pleural fluid analysis and diagnostic imaging assist in differentiation from other causes of pleural effusion. We report a case of hydrothorax in a compensated cirrhotic patient after recent introduction to peritoneal dialysis.

Keywords: Hydrothorax; Liver cirrhosis; Peritoneal dialysis

Fig. 1.

Chest X-ray shows pleural effusion in right chest.

Fig. 2.

Abdominal CT shows ascites and hepatic cirrhosis.

Fig. 3.

Tc-99m peritoneography shows migration of the radiotracer into the right thoracic cavity.

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