Diagnosis by Peritoneal scintigraphy of Peritoneal Dialysis–Associated Hydrothorax in an Infant

Abstract

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Pleuroperitoneal Leak as an Uncommon Cause of Pleural Effusion in Peritoneal Dialysis: A Case Report and Literature Review

“…Both ultrasound and X-ray can confirm the presence of effusion, but not the source of the fluid. Peritoneal scintigraphy is considered an excellent modality to diagnose a pleuroperitoneal leak, but the sensitivity has been reported to be only 40% to 50%, and its utility in locating the site of the pleuroperitoneal communication is limited [ 4 , 7 , 9 ]. In a case report, Kang and Kim suggested that CT peritoneography with intraperitoneal contrast could confirm and locate the pleuroperitoneal fistula [ 10 ].…”

The Role of SPECT/CT in Peritoneal Scintigraphy in the Era of Low-Dose Imaging: A Case Report

“… 3 Pathogenesis of peritoneal dialysis catheter-associated hydrothorax has been reported to originate from congenital or acquired defects of the diaphragm, defective lymphatic drainage, and pleuroperitoneal communication via a fistulous tract. 4 …”

Mechanical Complications of Peritoneal Dialysis

“…Like the symptoms of local edema, symptoms of hydrothorax often manifest upon dialysate influx, or directly after indwelling [68]. Because these symptoms could be misdiagnosed as congestive heart failure or inadequate dialysis, an early and accurate diagnosis is crucial to management.…”

“…Additionally, the presence of increased glucose levels in the pleural fluid is suggestive of a pleuro-peritoneal communication, although this does not manifest in all patients and should not be relied upon as the sole means of diagnosis [59,70,72]. Instead, there is increasing use of peritoneal scintigraphy [68,69,[73][74][75][76], which allows not only for accurate diagnosis of fluid overload and transudative pleural effusion but also allows for the identification and localization of diaphragmatic defects without thoracoscopic intervention.…”

“…Many of the diagnostic tools used to detect leaks elsewhere in the body are useful in diagnosing PD-associated hydrothorax. Common methods of diagnosis are chest CT [68], X-ray imaging [70], or ultrasonography [68]. These methods can confirm the presence of fluid in the pleural space, but do not allow for appreciation of the underlying etiology of a diaphragmatic defect, which can lead to an alternate diagnosis [71].…”