Prognosis of patients with rounded atelectasis undergoing long-term hemodialysis

We present 4 patients undergoing hemodialysis in whom thoracic computed tom ography (CT) suggested a diagnosis of rounded atelectasis (RA) with pleural effusion. The clinical setting and follow-up CT of all 4 patients confirme d this diagnosis. The pleural fluid of each appeared serosanguineous or hem orrhagic and predominantly consisted of lymphocytes. Biochemical analysis o f this fluid revealed high levels of total protein, lactate dehydrogenase a nd glucose. Bacterial culture and polymerase chain reaction for Mycobacteri um tuberculosis DNA was negative. Pleural biopsy specimens from 2 of the 4 patients showed evidence of fibrinous change and mesothelial cell hyperplas ia. Pleural effusion from all 4 patients did not respond to either fluid re striction or aggressive hemodialysis-induced dehydration. The subsequent cl inical course and thoracentesis were repeated, and in 1 patient, this was f ollowed by tetracycline pleurodesis. However, 2 patients died during pre-pl eurodesis and 1 died during post-pleurodesis, ail due to respiratory failur e. We propose that the clinical setting and follow-up thoracic CT and thora centesis of patients receiving long-term hemodialysis confirmed a diagnosis of rounded atelectasis with uremic pleural effusion. We also propose that the prognosis of patients with refractory pleural effusion receiving long-t erm hemodialysis would be improved by early pleurodesis. Copyright (C) 2001 S. Karger AG, Basel.