Cough-lnduced Hydrothorax in Peritoneal Dialysis

A 36-year-old male with renal failure secondary to focal and segmental glomerulosclerosis had been on peritoneal dialysis for 22 months. He developed an upper respiratory infection with a persistent cough. During a vigorous coughing episode while filled with 2 L of dialysate, he developed acute dyspnea. Examination revealed decreased breath sounds and dullness to percussion over the right thorax. Chest x-ray confirmed a large right pleural effusion (Figure 1). Thoracentesis revealed a transudative pleural effusion with a glucose concentration of 415 mg/dL. Hemodialysis was performed for 6 weeks to allow the defect in the diaphragm to heal