Massive hydrothorax in continuous ambulatory peritoneal dialysis: diagnosis, management and review of the literature.

Recurrent massive hydrothorax is an uncommon but serious complication in patients on continuous ambulatory peritoneal dialysis (CAPD). Accurate confirmative diagnostic procedures of the pleuroperitoneal communication is lacking and the management remains difficult. We reported three patients who developed massive hydrothorax at different periods after commencement of CAPD treatment (1.5-9 months). These patients underwent different investigatory procedures for demonstrating the pleuroperitoneal communication. We conclude that both technetium 99m-tagged macroaggregated albumin intraperitoneal radionuclide scan and stereoisomeric analysis of lactate in the peritoneal and pleural fluid are safe and reliable procedures to demonstrate the pleuroperitoneal communication. The massive hydrothorax was successfully treated in two patients by pleurodesis induced by intrapleural administration of oxytetracycline combined with 10-days small volume intermittent peritoneal dialysis. The clinical findings of 18 other cases previously reported in the literature are also reviewed.