Pleural effusion from pleuroperitoneal communication

A 52yearold woman with endstage renal disease for chronic glomerulonephritis was started on inpatient peritoneal dialysis (PD). We increased infusion volume of PD exchange every 2 days without observing any symptoms, including respiratory symptoms. After changing infusion volume on the 5th day, the patient complained of dyspnea and continuous cough. Decreased breath sounds were noted in the right lung field; chest Xray revealed rightsided pleural effusion (Figure 1). Pleurocentesis revealed clear and transparent pleural fluid, consistent with a transudative type of effusion. Pleural fluid and serum glucose levels were 325 and 115 mg/dL, respectively, both suggesting that the effusion came from the dialysate fluid because of pleuroperitoneal communication. Isotopic peritoneography with technetium99mlabeled macroaggregated albumin revealed a prompt reflux of the tracer in the right pleural space (Figure 2), which confirmed the presence of a rightsided pleuroperitoneal communication. PD was discontinued and switched