Background: Peritoneal dialysis can be associated with various mechanical complications. Among them, pleuroperitoneal leak leading to recurrent hydrothorax is a lesser known entity. The condition can lead to life-threatening complications like respiratory distress, cardiac failure, arrhythmias, and infections. Various imaging modalities like computerized tomography, magnetic resonance imaging, and nuclear scans have been used to establish the diagnosis of pleuroperitoneal leak. Case Presentation: An elderly gentleman with multiple co-morbidities on peritoneal dialysis presented with recurrent hydrothorax. After ruling out cardiac, infective, and neoplastic etiologies as causes for hydrothorax, the diagnosis of pleuroperitoneal leak was established using computerized tomography peritoneography. Despite temporarily interrupting peritoneal dialysis, our patient developed recurrent hydrothorax, thus requiring to be transferred to hemodialysis. Conclusion: A high index of clinical suspicion and choice of the imaging modality will help in the timely diagnosis of pleuroperitoneal leak and appropriate therapeutic intervention.

Keywords: Pleuroperitoneal leak, hydrothorax, peritoneal dialysis, CT peritoneography.