SPECT/CT to diagnose pleuroperitoneal communication-associated hydrothorax in peritoneal dialysis

Nishiyama, Kei; Fukui, Kenji; Jo, Tohaku; Miyai, Takayuki; Kanda, Shoichiro; Sato, Noriko; Ishizuka, Kiyonobu; Chikamoto, Hiroko; Akioka, Yuko; Hattori, Motoshi

doi:10.1038/ki.2014.266

Cited by 7 publications

(5 citation statements)

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“…There have been few reports on the diagnosis of PD with adjacent tissue perforation using SPECT/CT, only subcutaneous leakage and pleuroperitoneal fistula, and no case report of organ perforation (18)(19)(20). The commonly employed diagnostic method for visceral perforation is X-ray contrast imaging.…”

Section: Discussionmentioning

confidence: 99%

Confirmation of intestinal and bladder perforations in a peritoneal dialysis patient using SPECT/CT: a case report and review of literature

Zhang,

Hu,

Jing

et al. 2024

Front. Med.

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BackgroundPeritoneal dialysis (PD) is a common treatment method for patients with renal failure. While peritonitis and tube floating migration are commonly observed complications, visceral perforation caused by PD is relatively rare. We present a case report of a patient undergoing PD due to renal failure, who encountered two instances of visceral perforation. In both occurrences, Single-Photon Emission Computed Tomography/Computed Tomography (SPECT/CT) played a pivotal role in providing accurate diagnoses and precise localization of the perforation sites. This report underscores the paramount significance of SPECT/CT in diagnosing visceral perforations in the context of PD.Case presentationA 73-year-old elderly male has been undergoing PD for 1 year due to renal failure. Recently, there has been impaired drainage of the PD catheter. The clinical team suspected the occurrence of peritonitis. The patient underwent a 99mTc Sodium Pertechnetate (99mTc-NaTcO4) SPECT/CT examination, which identified intestinal perforation. After 20 days of conservative treatment, a SPECT/CT follow-up examination revealed the resolution of the intestinal perforation, but a new bladder perforation emerged. The dialysis catheter was methodically and gradually withdrawn in stages while simultaneously performing bladder decompression. Following these interventions, the patient remained free from peritonitis and cystitis.ConclusionThe utilization of SPECT/CT proved to be highly valuable in the accurate diagnosis of visceral perforation, a relatively rare complication observed in PD patients.

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Section: Discussionmentioning

confidence: 99%

Confirmation of intestinal and bladder perforations in a peritoneal dialysis patient using SPECT/CT: a case report and review of literature

Zhang,

Hu,

Jing

et al. 2024

Front. Med.

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“…The sensitivity of CT and MRI peritoneography is approximately 30%, and even peritoneal scintigraphy without showing the exact defect has a sensitivity of 50% 9 10. Because SPECT has a short history, accumulating more cases is needed to verify its sensitivity 11. Analysis of pleural fluid to serum glucose gradients also has been used, but it has many problems, such as the absence of a consensus criterion value 12…”

Section: Discussionmentioning

confidence: 99%

Optimal imaging conditions for the diagnosis of pleuroperitoneal communication

et al. 2019

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A 70-year-old woman with end-stage renal disease caused by a polycystic kidney disease developed massive right-sided pleural effusion 10 days after the initiation of peritoneal dialysis (PD). Although pleuroperitoneal communication (PPC) was suspected, computed tomographic peritoneography on usual breath holding did not show leakage. Therefore, we instructed her to strain with maximal breathing, which caused a jet of contrast material to stream from the peritoneal cavity into the right pleural cavity and allowed the identification of the exact site of the diaphragm defect. Following the thoracoscopic closure of the defect, she was discharged without recurrence of hydrothorax on PD. Hydrothorax due to PPC is a rare complication of PD. Notably, numerous previous modalities used to diagnose PPC lack sufficient sensitivity. Thus, an approach to spread the pressure gradient between the peritoneal cavity and the pleural cavity on imaging may improve this insufficient sensitivity.

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“… 16 , 17 Alternatively, peritoneal scintigraphy may help confirm such a leak by demonstrating increased supradiaphragmatic radioactivity, as shown in the present patient. 7 , 13 , 14 , 18 A permanent shift from PD to HD has been suggested as one therapeutic option for treating PPC. 7 , 8 Other strategies include low volume exchanges and cessation of the procedure for 2 to 6 weeks, although temporary HD may be required as well especially in the subjects with minimal residual renal function.…”

Section: Discussionmentioning

confidence: 99%

“…8,21 Our proposed diagnostic workup is shown in Figure 3. 7,8,[13][14][15][16][17][18][19][20] Patients maintained on a chronic dialysis treatment are potentially at an increased risk of cancer, which often follows a locoregional pattern, with the kidney and bladder being the most common sites. 22 Epidemiologically established risk factors for ovarian cancer include family history, nulliparity, infertility, and early or late menarche.…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Pleuroperitoneal Communication and Ovarian Cancer Complicating Peritoneal Dialysis: A Case Report of a Patient with End-Stage Kidney Disease

Akimoto

Yamazaki

Kohara

et al. 2017

Clin Med Insights Case Rep

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Peritoneal dialysis has been a widely accepted modality for treating end-stage kidney disease, but a regular dialysis schedule can be seriously disrupted by various comorbid conditions requiring surgical intervention. A 40-year-old woman who had been receiving peritoneal dialysis was sequentially but separately complicated by pleuroperitoneal communication and ovarian cancer. Despite the need for temporary interruption of her peritoneal dialysis schedule, it was successfully resumed after the relevant surgeries for each disease. Several concerns regarding overall postoperative dialytic management strategies, including how to deal with the peritoneal dialysis catheter during the postoperative period as well as how long peritoneal dialysis should be interrupted, which remain an unresolved issue in the field of nephrology, are also discussed.

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SPECT/CT to diagnose pleuroperitoneal communication-associated hydrothorax in peritoneal dialysis

Cited by 7 publications

References 0 publications

Confirmation of intestinal and bladder perforations in a peritoneal dialysis patient using SPECT/CT: a case report and review of literature

Confirmation of intestinal and bladder perforations in a peritoneal dialysis patient using SPECT/CT: a case report and review of literature

Optimal imaging conditions for the diagnosis of pleuroperitoneal communication

Pleuroperitoneal Communication and Ovarian Cancer Complicating Peritoneal Dialysis: A Case Report of a Patient with End-Stage Kidney Disease

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