Pleuroperitoneal Communication

Peritoneal Dialysismedium

A 57-year-old woman on CAPD develops a new right-sided transudative pleural effusion after several weeks of increasingly difficult ultrafiltration. The pleural fluid is clear, and its glucose concentration is higher than the serum glucose. What is the most likely diagnosis?

  1. A.Community-acquired pneumonia
  2. B.Diaphragmatic leakCorrect
  3. C.Uremic pleuritis
  4. D.Tuberculous pleuritis

Explanation

A pleural effusion with pleural glucose higher than serum glucose in a PD patient strongly suggests pleuroperitoneal communication through a diaphragmatic defect. Dialysate tracks into the pleural space, usually causing a right-sided transudative effusion. The diagnosis is supported by a pleural fluid-to-serum glucose ratio >1 or a markedly elevated pleural glucose concentration relative to serum.

Why each option

A.
Incorrect. Pneumonia would usually produce an exudate and systemic infectious features.
B.
Correct. PD dialysate can leak through the diaphragm into the pleural space.
C.
Incorrect. Uremic pleuritis is not characterized by pleural glucose higher than serum.
D.
Incorrect. TB pleuritis is usually exudative and does not give this glucose pattern.

Reference: Low pleural fluid-to-serum glucose gradient indicates pleuroperitoneal communication in peritoneal dialysis patients: a review of the literature. Perit Dial Int. 2011.

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