Acute hydrothorax is an
uncommon but a well-recognized complication of peritoneal dialysis. No single
test is definitive for diagnosis. Diagnosis becomes a challenge.
Peritoneal
dialysis-(PD) related hydrothorax was first reported in 1967 by Edward
and Unger in JAMA( see attached). Transudative pleural effusion develops,
more commonly involving the right side, and usually occurs immediately after
starting PD or a few days later. The patients may remain asymptomatic or have
sudden dyspnea, decrease in ultrafiltration, or pleuritic chest pain.
How do we diagnose it?
Presence
of high pleural-fluid glucose concentration.
Pleural
fluid concentration of glucose >300mg/dl might be diagnostic.
Others have hypothesized
that, given dynamic movement of dialysate, an absolute glucose-concentration
level cannot be used to diagnose PD-related hydrothorax. The pleural
fluid-to-serum glucose concentration gradient of greater than 2.77 mmol/L (50
mg/dl) was proposed as the cut-off to diagnose the condition.
In
general, any pleural-fluid glucose concentration greater than serum is
considered to be highly supportive of PD-related hydrothorax.
Imaging:
1.Radionuclide
scan (for example, Tc-99 m DTPA) is associated with sensitivity of 40% to 50%.
2.The methylene blue test has been used where its injected and dye is traced from the peritoneum to the pleura. In one study showed no sensitivity and is associated with a risk of chemical peritonitis.
2.The methylene blue test has been used where its injected and dye is traced from the peritoneum to the pleura. In one study showed no sensitivity and is associated with a risk of chemical peritonitis.
Some
case report examples in literature
Check out
this powershow that reviews
the management of this entity.