Introduction Pleural effusion is a recognized complication of peritoneal dialysis (PD), with pleuroperitoneal communication (PPC) representing a rare but clinically significant cause. Patients typically present with dyspnea, reduced ultrafiltration volume and edema. Case presentation A 52-year-old woman on daily peritoneal dialysis reported progressive dyspnea and chronic localized chest pain, which is an uncommon presentation. Imaging revealed a massive right-sided pleural effusion, and pleural