An 8-year-old girl who had undergone chronic hemodialysis for 1 year p
resented with respiratory distress 24 h after a hemodialysis session.
She had a massive pleural effusion of the left chest that was shown to
be hemothorax by thoracentesis. After chest tube insertion, drainage
was maintained for 2 days. Pleural effusion recurred after withdrawal
of the chest tube. The antecubital arteriovenous fistula on the left a
rm was found to have an excessive flow with a thrill which was felt al
l over her left shoulder and left hemithorax. The pleural effusion res
olved spontaneously a week after ligation of the fistula. Excessive fl
ow in the arteriovenous fistula was thought to be the cause of the hem
othorax and should be included in the differential diagnosis of hemoth
orax in hemodialysis patients.