Intended for healthcare professionals

Endgames Spot Diagnosis

A woman with acute dyspnoea

BMJ 2020; 368 doi: (Published 30 January 2020) Cite this as: BMJ 2020;368:l6970
  1. Qiaoling Zhou, nephrology ST5 registrar,
  2. Madhu Potluri, nephrologist consultant
  1. Gloucestershire Royal Hospital NHS Foundation Trust, Gloucestershire, UK
  1. Correspondence to Q Zhou qz8028{at}

A 60 year old woman with end stage renal disease presented with acute dyspnoea over three days.

Her end stage renal disease was secondary to diabetic nephropathy and she had been on daily automated peritoneal dialysis for more than 24 months. She had no other medical history. In the three weeks before her admission, she reported increasing leg oedema and reducing fluid removal from the automated peritoneal dialysis. She noticed that her symptoms of breathlessness worsened whenever she had the dialysates infused.

Examination revealed markedly reduced breath sounds and dull percussion over the left hemithorax.

Chest radiography (fig 1) showed a …

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