ArticleFrontiers in medicine2026
Case report and review of the literature: multiplanar CT as a supportive diagnostic tool in pleuroperitoneal leak during peritoneal dialysis.
Article in Frontiers in medicine, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Introduction: Pleural effusion is a recognized complication of peritoneal dialysis (PD), with pleuroperitoneal communication (PPC) representing a rare but clinically significant cause. Patients typically present with dyspnea, reduced ultrafiltration volume and edema. Case presentation: A 52-year-old woman on daily peritoneal dialysis reported progressive dyspnea and chronic localized chest pain, which is an uncommon presentation. Imaging revealed a massive right-sided pleural effusion, and pleural fluid analysis showed a transudate based on Light's criteria with markedly elevated glucose concentration. Computed tomography (CT) with multiplanar reconstruction demonstrated findings suggestive of a focal diaphragmatic discontinuity, however, the defect was not clearly visualized and no functional confirmation of pleuroperitoneal communication was achieved. Peritoneal dialysis was discontinued, and the patient was transitioned to hemodialysis (HD). The pleural effusion resolved completely in 5 days without further complications. Discussion: This case highlights the importance of considering pleuroperitoneal communication in PD patients with pleural effusion and chest pain. Due to the absence of a clearly defined gold standard, the diagnosis can be challenging. A key diagnostic marker for pleuroperitoneal leak is an elevated glucose concentration in the pleural fluid. Several imaging techniques can aid diagnosis but generally suffer from relatively low sensitivity. Conclusion: Pleuroperitoneal leak is a rare but severe complication of PD. According to our experience, CT with multiplanar reconstruction provided anatomical findings suggestive of a diaphragmatic defect, and, in addition to pleural fluid biochemical analysis, helped strengthen the diagnostic suspicion of PPC. However, further studies comparing imaging findings with surgical confirmation are needed to determine its true diagnostic accuracy and its reliability in identifying the diaphragmatic defect.
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