Hydrothorax
Hydrothorax typically presents as a right-sided pleural effusion due to a pleuroperitoneal communication which allows dialysate to enter the pleural cavity.1 Diagnosis is confirmed by aspirating pleural fluid and determining that the pleural fluid glucose concentration is higher than the plasma glucose.2 Alternatively, the diagnosis of pleuroperitoneal fistula can be established with peritoneal scintigraphy showing radioisotope in the thoracic cavity or MRI. Temporary cessation of PD allows for the slow reabsorption of dialysate, but more rapid drainage of the pleural dialysate can be achieved by pleural aspiration procedures such as a thoracentesis.
Hydrothorax may be acquired after heavy exertion or congenital due to innate diaphragmatic defects. If acquired, the hydrothorax may resolve after cessation of PD.3 If congenital, the diaphragmatic defects require repair procedures—most commonly done by video-assisted thoracoscopy.4