Abstract
Acute, massive, unilateral hydrothorax is an uncommon but easily recognized complication of continuous ambulatory peritoneal dialysis (CAPD). Its clinical course and treatment outcome, with recently advocated variable techniques including interruption of CAPD alone, pleurodesis via chest drain, and video-assisted thoracoscopic surgery (VATS) with pleurodesis, remains unclear. We herein present a patient with CAPD-related massive hydrothorax who was diagnosed as having a diaphragmatic defect. VATS with direct suture of the flaw and pleurodesis were performed successfully. This revealed that the defect was attributable to the rupture of a small bleb in the diaphragmatic dome. After the operation, the patient had no recurrence of hydrothorax and underwent CAPD safely. We strongly suggest VATS with direct suture and pleurodesis, as the modality of choice, for diaphragmatic defects in patients on CAPD.
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