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REVIEWS |
Division of Renal Diseases and Hypertension, Department of Medicine, George Washington University, Washington, DC, USA
Correspondence to: S. Lew, 2150 Pennsylvania Avenue, NW, Room 3-438, Washington, DC 20037, USA. sqlew{at}gwu.edu
ABSTRACT
Hydrothorax in a patient treated with peritoneal dialysis (PD) poses a
diagnostic dilemma. Hydrothorax due to migration of dialysis fluid across the
diaphragm and into the pleural space creates a serious complication of PD but
generally does not threaten life. Shortness of breath causes the patient to
seek medical attention. A sudden diminution in dialysis adequacy or poor
ultrafiltration rate constitutes a unique marker for patients treated with PD
compared to the general population. This article reviews the etiology for
hydrothorax specifically in the PD population. Thoracentesis with chemical
analysis of the fluid, imaging studies with and without contrast or markers,
and video-assisted thoracoscopic surgery play important roles in the
evaluation of hydrothorax. A conservative PD regimen, surgical intervention,
and pleurodesis provide treatment options to those receiving PD.
KEY WORDS: Hydrothorax; pleural effusion; thoracentesis; video-assisted thoracoscopic surgery; pleurodesis.
Received 29 June 2008; accepted 3 February 2009.
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