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Pleuroperitoneal Leak PD Diagnosis — ESENeph MCQ

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ModeratePeritoneal DialysisPleuroperitoneal Leak PD DiagnosisESENeph

A 58-year-old man on peritoneal dialysis develops progressively increasing fluid in his right hemithorax on chest X-ray. He has no symptoms of infection. PD effluent is clear. A diagnostic pleural tap reveals a glucose concentration significantly higher than serum glucose, and protein concentration lower than expected for a transudative effusion. What is the most likely diagnosis?

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Correct answer: A — Pleuroperitoneal communication (dialysate leak into pleural space)

Pleuroperitoneal communication is a recognised complication of PD where dialysate leaks from the peritoneal cavity into the pleural space through diaphragmatic defects (usually congenital diaphragmatic pores or acquired defects, predominantly right-sided). The pathognomonic finding is pleural fluid glucose concentration HIGHER than serum glucose (from the glucose-containing dialysate) and low protein. Diagnosis can be confirmed by adding methylene blue to the PD dialysate and observing blue-tinged pleural fluid. Management options include temporary cessation of PD with switch to HD, chemical pleurodesis (talc), or surgical repair of the diaphragmatic defect (VATS). Small defects may close spontaneously with 2-4 weeks of PD rest.

Reference: Nomoto et al 1989 – Pleuroperitoneal Communication PD; ISPD 2020 – PD Complications