SPONTANEOUS HEMOTHORAX IN A HEMODIALYSIS PATIENT

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.