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Case Reports
. 2019 Mar 31;12(3):e228940.
doi: 10.1136/bcr-2018-228940.

Optimal imaging conditions for the diagnosis of pleuroperitoneal communication

Takashin Nakayama  1 , Kohei Hashimoto  2 , Takeshi Kiriyama  3 , Keita Hirano  1
Affiliations
Case Reports

Optimal imaging conditions for the diagnosis of pleuroperitoneal communication

Takashin Nakayama et al. BMJ Case Rep. .

Abstract

A 70-year-old woman with end-stage renal disease caused by a polycystic kidney disease developed massive right-sided pleural effusion 10 days after the initiation of peritoneal dialysis (PD). Although pleuroperitoneal communication (PPC) was suspected, computed tomographic peritoneography on usual breath holding did not show leakage. Therefore, we instructed her to strain with maximal breathing, which caused a jet of contrast material to stream from the peritoneal cavity into the right pleural cavity and allowed the identification of the exact site of the diaphragm defect. Following the thoracoscopic closure of the defect, she was discharged without recurrence of hydrothorax on PD. Hydrothorax due to PPC is a rare complication of PD. Notably, numerous previous modalities used to diagnose PPC lack sufficient sensitivity. Thus, an approach to spread the pressure gradient between the peritoneal cavity and the pleural cavity on imaging may improve this insufficient sensitivity.

Keywords: cardiothoracic surgery; chronic renal failure; dialysis; renal intervention.

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Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Chest radiography. (A) There was no pleural effusion before the initiation of peritoneal dialysis (PD). (B) A massive right pleural effusion shifting the mediastinum was detected 10 days after the initiation of PD.
Figure 2
Figure 2
CT peritoneography. (A) Sagittal view showing a jet of contrast material (red arrow). (B) A three-dimensional reconstructed image showing the whole image with a jet of contrast material (red linear mass).
Figure 3
Figure 3
Thoracoscopy showing CO2 leakage (dotted black arrow) and the diaphragm defect (solid black arrow).
See this image and copyright information in PMC

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