Abstract
We have successfully treated a patient with a massive right-sided hydrothorax by instillation of fibrin glue and antiplasmin into the thoracic cavity.
A 29-year-old man had entered the CAPD program in April 1990. Following the induction of CAPD, he developed chest pain, cough and dyspnea for two months. A chest x-ray film showed a right-sided massive hydrothorax. Radionuclide studies (99m Tc-sulphurcolloid) proved a pleuro-peritoneal communication. Interruption of CAPD for 7 days did not prevent re-accumulation of the pleural effusion when the CAPD was restarted. After complate evacuation of the pleural effusion, fibrin glue was infused into the thoracic cavity. He developed only mild chest pain and a slight fever after administration of the drug. Twenty-one days later, CAPD was restarted again and a recurrence of the pleural effusion was noted. After the addition of antiplasmin however, the pleural effusion did not reaccumulate.
As for pleurodesis after failure in treating hydrothorax by temporary interruption of CAPD, talc, tetracycline, and autologous blood have been tried. However, these substances are not completely effective and are associated with moderate or severe discomfort.
In our experience, fibrin glue and antiplasmin eradicated the pleuro-peritoneal communication without any untoward effect.
