Unilateral pleural effusions associated with stenoses of left brachiocephalic veins in haemodialysis patients

Abstract

Pleural effusion is a frequent complication in patients undergoing haemodialysis. Its more common causes are congestive heart failure, infection, neoplasm and so-called uraemic pleurisy [1,2]. When the work-up of a pleural effusion in a haemodialysis patient does not identify a specific cause, it is usually attributed to uraemic pleurisy [3]. Uraemic pleural effusions have been estimated to develop in 3–10% of patients with advanced renal failure [4]; however, the diagnosis of uraemic pleurisy remains elusive, as no pathognomonic test is available. We report here on two haemodialysis patients with a novel cause of pleural effusion. In each case, the sum of a severe stenosis in the left brachiocephalic vein and the increased venous flow of an ipsilateral arteriovenous (AV) fistula coincided with the appearance of a massive left sided pleural effusion. Percutaneous venous angioplasty in one patient and ligation of the AV fistula in the other led to dramatic resolutions of the pleural effusions.