Hemothorax in Dialysis Patients: The Importance of History and Differential Diagnoses

Our plain-English summary of Hemothorax in Dialysis Patients: The Importance of History and Differential Diagnoses, by M. Cabrio, M.C. Ribeiro Silva, M.V. Leite, et al (Current Health Sciences Journal, 2026).

The study

• Authors: M. Cabrio, M.C. Ribeiro Silva, M.V. Leite, A.A. Cetlin
• Journal: Current Health Sciences Journal
• Published: 2026;52(1):118-121
• Type of article: Case report
• Read it: PubMed · Publisher · Free full text

Abstract

Long-term double-lumen central venous catheters are commonly used in patients undergoing hemodialysis but may be associated with rare and serious complications, such as injury to large veins, for example the jugular or subclavian vein. We report the case of a 42-year-old man with chronic kidney disease on hemodialysis and a history of treated extrapulmonary tuberculosis who was found to have a massive, asymptomatic, left-sided hemothorax. Differential diagnoses included tuberculosis recurrence, mesothelioma, and iatrogenic vascular injury related to a long-term catheter. This case underscores the importance of careful clinical history and differential diagnosis when evaluating pleural effusion in dialysis patients.

Copyright © 2025, Medical University Publishing House Craiova.

In plain English

This case report from Brazil described a 42-year-old man with chronic kidney disease. He had started hemodialysis 10 years earlier, later through a long-term catheter after losing arteriovenous fistulas to infection, and had completed six months of treatment for mediastinal lymph node tuberculosis. He arrived without symptoms but with fluid around the left lung. Fluid drawn by needle looked bloody, and a rapid tuberculosis test was negative. At surgery, doctors found about 2000mL of dark bloody fluid and thickened pleura. Traces of tuberculosis DNA were found in the fluid, but smear and culture were negative; the biopsy showed chronic nonspecific pleuritis. The authors weighed tuberculosis, pleural mesothelioma and catheter injury. Discussing asbestos, they noted the patient, a truck driver, had no occupational exposure, and the biopsy ruled out mesothelioma. The medical team suspected an iatrogenic cause, meaning one caused by medical treatment, and the authors reached this conclusion after ruling out other diagnoses and seeing no return of fluid after drainage. They noted that a fluid hematocrit test was not performed.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: Case report (single patient)
• Who was studied: One 42-year-old man in Brazil with type I diabetes, hypertension and chronic kidney disease. He started hemodialysis 10 years before the report. A long-term catheter was implanted after he lost his arteriovenous fistulas to infection; how long the catheter had been in place is not stated. He had previously been treated for mediastinal lymph node tuberculosis.
• Exposure: No asbestos exposure. The authors state the patient, a truck driver, had no occupational exposure. The exposure considered as the cause was a long-term hemodialysis catheter in the left internal jugular vein, on the same side as the effusion.
• Main results:
  • Thoracentesis (drawing fluid with a needle) showed a bloody-appearing exudate with few white blood cells.
  • Surgery (decortication) after 19 days found approximately 2000mL of fluid on the left side, with diffuse pleural thickening.
  • The pleural biopsy showed chronic nonspecific pleuritis with fibrotic thickening and areas of hemorrhage.
  • The authors interpreted the traces of tuberculosis bacteria found in the surgically collected fluid as remnants of the previously treated lymph node tuberculosis.
  • Pleural mesothelioma was considered as a possible diagnosis, and the pleural biopsy ruled it out.
  • No recurrence was observed after drainage.
• The authors' conclusion: The authors wrote that the asymptomatic bloody effusion lasting over six months led the medical team to suspect an iatrogenic cause, and that this conclusion was reached after discarding other possible conditions and because there was no recurrence after drainage. They stated that catheter-related complications, although rare, should be considered after infectious and neoplastic causes are excluded.
• Limitations the authors state:
  • The ratio of fluid hematocrit to blood hematocrit, which the authors say could have suggested trauma and hemothorax, was not measured.

Topics

Medical terms in this study, explained in our Lexicon: Hemothorax, Mesothelioma, Differential Diagnosis, Pleural Effusion.

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