Which signs suggest a pleuroperitoneal leak in a patient on peritoneal dialysis?

• A. Cough with sputum
• B. Weight gain alone
• C. Shortness of breath, chest pain, and new pleural effusion after long dwells.
• D. Increased urine output

Answer: (C)

When a patient on peritoneal dialysis develops a pleuroperitoneal leak, dialysate escapes into the pleural space through a diaphragmatic defect. The result is a new pleural effusion that often becomes evident after longer dwell times, when more dialysate has accumulated and the pressure gradient favors leakage. The most telling signs are shortness of breath and chest pain that coincide with the presence of a new pleural effusion on imaging after long dwell periods. This combination points to a pleuroperitoneal leak rather than a simple fluid overload or another pulmonary issue.

Cough with sputum suggests infection or airway irritation rather than a pleural leak. Weight gain alone can reflect volume overload but does not specifically indicate a leak into the chest. Increased urine output indicates preserved or recovering renal function, not a complication of PD.