Nakayama Takashin, Hashimoto Kohei, Kiriyama Takeshi, Hirano Keita
Department of Internal Medicine, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan.
Department of Thoracic Surgery, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan.
BMJ Case Rep. 2019 Mar 31;12(3):e228940. doi: 10.1136/bcr-2018-228940.
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.
一名70岁患有多囊肾病所致终末期肾病的女性，在开始腹膜透析（PD）10天后出现大量右侧胸腔积液。尽管怀疑存在胸膜腹膜交通（PPC），但常规屏气时的计算机断层扫描腹膜造影未显示渗漏。因此，我们指导她在最大呼吸时用力，这使得一股造影剂从腹腔流入右胸腔，从而确定了膈肌缺损的确切部位。在胸腔镜下封闭缺损后，她出院了，腹膜透析时胸腔积液未复发。PPC所致胸腔积液是腹膜透析的一种罕见并发症。值得注意的是，以前用于诊断PPC的众多方法缺乏足够的敏感性。因此，一种在成像时扩大腹腔与胸腔之间压力梯度的方法可能会改善这种敏感性不足的情况。
