Diaphragmatic Defect Complicating Peritoneal Dialysis

Abstract

A 48-year-old woman with end-stage renal disease presented with chest heaviness and dyspnea after initiating peritoneal dialysis (PD). A large right pleural effusion and compressive atelectasis were noted on computed tomographic scan (Fig 1). Pleural and peritoneal dialysis fluids were chemically identical. During thoracoscopy, diaphragmatic defects and blebs were localized with methylene blue added to the PD fluid (Fig 2). Suture repair was performed (Fig 3) and was reinforced with fibrin glue accompanied by local mechanical pleurodesis.