Hydrothorax caused by a bleb of the diaphragm in a continuous ambulatory peritoneal dialysis patient.

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  • 横隔膜ブレブ（ｂｌｅｂ）により右胸水を生じたＣＡＰＤ患者の１例

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We report a continuous ambulatory peritoneal dialysis (CAPD) patient with hydrotherax caused by blebs of the diaphragm. A 46-year-old man began on CAPD therapy for end-stage renal disease due to diabetic nephropathy. Three weeks later, right massive pleural effusion was demonstrated by a chest X-p associated with decreased net ultrafiltration. A 99mTc-MAA (technetium-macroaggregated albumin) radionuclide scan showed a communication between the abdominal and the right pleural cavities. He was unsuccesfully treated by pleurodesis using his blood. Some bleb formation at a tendinous part of the right diaphragm was revealed by thoracoscopy when the CAPD dlalysate was infused into the peritoneal cavity. In order to make the blebs adhere, fibrinogen and thrombin had been sprayed around them. Three weeks later, CAPD therapy was restarted, but retention of pleural effusion occurred repeatedly. Ultimately, his treatment was changed to hemodialysis. Hydrothorax due to an abnormal pleuroperitoneal communication is one of the complications of CAPD. By using a thoracoscope, blebs were observed in the tendinous part as the cause of the hydrothorax associated with CAPD.

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