Binnani Pooja, Gupta Ruchi, Kedia Nikhil, Bahadur M M
Department of Nephrology, Jaslok Hospital and Research Centre, Mumbai, India.
Saudi J Kidney Dis Transpl. 2012 Jan;23(1):106-9.
Pleural effusion is a frequent complication in patients undergoing hemodialysis (HD). We report a patient on HD with a novel cause of recurrent unilateral pleural effusion. A 45-year-old female patient on long-term maintenance HD presented to us with recurrent unilateral pleural effusion. She had a history of poor quality dialysis, severe anemia and severe hypertension. Despite correcting these factors and even after undergoing successful renal transplantation, she continued to have recurrent effusion. Left upper extremity venography demonstrated severe stenosis of the subclavian vein and an increased venous flow in the ipsilateral arteriovenous (AV) fistula. Ligation of the AV fistula led to dramatic resolution of the pleural effusion. Hemodialysis patients who develop unexplained pleural effusions ipsilateral to a functioning AV fistula should be investigated for stenosis in the brachiocephalic vein, particularly those patients who have had previous catheterizations of the jugular or subclavian veins on the same side as the effusion. Correcting the stenosis by venous angioplasty and/or ligation of the ipsilateral fistula can dramatically resolve the pleural effusion. A high index of suspicion is required to diagnose this complication for meaningful intervention.
胸腔积液是血液透析（HD）患者常见的并发症。我们报告了一例血液透析患者，其反复单侧胸腔积液的病因较为新颖。一名长期维持性血液透析的45岁女性患者因反复单侧胸腔积液前来就诊。她有透析质量差、严重贫血和严重高血压病史。尽管纠正了这些因素，甚至在成功进行肾移植后，她仍持续出现反复积液。左上肢静脉造影显示锁骨下静脉严重狭窄，同侧动静脉（AV）内瘘血流增加。结扎AV内瘘后胸腔积液显著消退。对于出现与功能正常的AV内瘘同侧不明原因胸腔积液的血液透析患者，应检查头臂静脉是否狭窄，尤其是那些在积液同侧曾行颈静脉或锁骨下静脉置管的患者。通过静脉血管成形术和/或结扎同侧内瘘纠正狭窄可显著消退胸腔积液。对于该并发症的诊断，需要高度怀疑指数才能进行有意义的干预。
