Usefulness of a pleuroperitoneal shunt for treatment of refractory pleural effusion in a patient receiving maintenance hemodialysis

Abstract

Refractory pleural effusion can be a life-threatening complication in patients receiving maintenance hemodialysis. We report successful treatment of refractory pleural effusion using a Denver® pleuroperitoneal shunt in one such patient. A 54-year-old Japanese man, who had previously undergone left nephrectomy, was admitted urgently to our department because of a high C-reactive protein (CRP) level, right pleural effusion, and right renal abscess. Because antibiotics proved ineffective and his general state was deteriorating, he underwent emergency insertion of a thoracic drainage tube and nephrectomy, and hemodialysis was started. Although his general state improved slowly thereafter, the pleural effusion, which was unilateral and transudative, remained refractory and therefore he needed to be on oxygenation. To control the massive pleural effusion, a pleuroperitoneal shunt was inserted. Thereafter, his respiratory condition became stable without oxygenation and he was discharged. His general condition has since been well. Although pleural effusion is a common complication of maintenance hemodialysis, few reports have documented the use of pleuroperitoneal shunt to control refractory pleural effusion. Pleuroperitoneal shunt has been advocated as an effective and low-morbidity treatment for refractory pleural effusion, and its use for some patients with recurrent pleural effusion has also been reported, without any severe complications. In the present case, pleuroperitoneal shunt improved the patient's quality of life sufficiently to allow him to be discharged home without oxygenation. Pleuroperitoneal shunt should be considered a useful treatment option for hemodialysis patients with refractory pleural effusion.

Keywords: Hemodialysis; Pleuroperitoneal shunt; Refractory pleural effusion.

Fig. 1

X-ray and CT scan on admission. a, b Right pleural effusion. c Right renal abscess. d Free air in the right kidney. e Right urolithiasis

Fig. 2

Clinical course of the patient after starting hemodialysis. a Indwelling catheter inserted into the right internal jugular vein. b, c Right pleural effusion. A drainage tube was inserted into the right thorax (b). Soon after the tube was removed, right pleural effusion developed (c). d, e Chest and abdominal X-ray on the insertion of the pleuroperitoneal shunt. f On discharge. The right pleural effusion was improved by the pleuroperitoneal shunt