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Optimal imaging conditions for the diagnosis of pleuroperitoneal communication
  1. Takashin Nakayama1,
  2. Kohei Hashimoto2,
  3. Takeshi Kiriyama3 and
  4. Keita Hirano1
  1. 1 Department of Internal Medicine, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
  2. 2 Department of Thoracic Surgery, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
  3. 3 Department of Radiology, Ashikaga Red Cross Hospital, Ashikaga, Tochigi, Japan
  1. Correspondence to Dr Takashin Nakayama, takashin.nakayama{at}


A 70-year-old woman with end-stage renal disease caused by a polycystic kidney disease developed massive right-sided pleural effusion 10 days after the initiation of peritoneal dialysis (PD). Although pleuroperitoneal communication (PPC) was suspected, computed tomographic peritoneography on usual breath holding did not show leakage. Therefore, we instructed her to strain with maximal breathing, which caused a jet of contrast material to stream from the peritoneal cavity into the right pleural cavity and allowed the identification of the exact site of the diaphragm defect. Following the thoracoscopic closure of the defect, she was discharged without recurrence of hydrothorax on PD. Hydrothorax due to PPC is a rare complication of PD. Notably, numerous previous modalities used to diagnose PPC lack sufficient sensitivity. Thus, an approach to spread the pressure gradient between the peritoneal cavity and the pleural cavity on imaging may improve this insufficient sensitivity.

  • chronic renal failure
  • dialysis
  • renal intervention
  • cardiothoracic surgery

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  • Contributors All authors were involved in the patient’s clinical care and approved the final manuscript. TN and KHa were involved in designing the study, collecting the data and writing the manuscript. TK was involved in designing the study and collecting the data. KHi was involved in collecting the data and revising the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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