Peritoneal dialysis (PD) confers many advantages, including a better quality of life for children with
end-stage renal disease; however, the procedure is associated with several complications, including pleuroperitoneal leaks. Here, we report an unusual case of
hydrothorax caused by long-term PD in a child, which was further complicated by
pneumonia. A 9-year-old boy who had received
CAPD for 22 months presented with
dyspnea, swelling, and increased
body weight.
Chest tube drainage yielded 500 mL of transudative fluid. Computed tomography peritoneography revealed increased outflow from the peritoneum to the pleural cavity. PD was suspended, and
hemodialysis (HD) was initiated. Video-assisted thoracoscopic surgery was performed; however, because the patient had
pneumonia during hospitalization, pleural adhesions with a septated appearance occurred. This resulted in difficulties identifying pleuroperitoneal
fistula (PPF). Right
pleural effusion resolved following
pleurodesis using
bleomycin. Regular HD was performed for 10 weeks, and PD was subsequently reinitiated. There was no recurrence of
hydrothorax during long-term follow-up. We suspect that the underlying mechanism of
hydrothorax in our patient was associated with a PPF that formed either due to a
congenital diaphragmatic defect or an acquired defect, resulting in
dialysate leakage. Our case demonstrates that a temporary switch from PD to HD, accompanied by
pleurodesis, may help resolve
hydrothorax that occurs as a complication of long-term PD.