Journal Information
Vol. 56. Issue 8.
Pages 524 (August 2020)
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Peritoneal scintigraphy scan in the diagnosis of pleuroperitoneal leak
Gammagrafía peritoneal en el diagnóstico de la comunicación peritoneo-pleural
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Juan José Martin-Marcuartu
Corresponding author
jjmarcuartu@gmail.com

Corresponding author.
, Paula Fernández-Rodríguez, Juan Luis Tirado-Hospital
Servicio de Medicina Nuclear, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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We report the case of a 48-year-old man with chronic kidney disease who developed weight gain associated with dyspnea, 2 months after starting peritoneal dialysis (PD). Examination revealed absent right breath sounds, and chest X-ray (Fig. 1a) confirmed the existence of massive pleural effusion. Thoracentesis was performed, yielding 1,600 ml of transudate in pleural fluid. Pleuroperitoneal leak was suspected, so the nuclear medicine department was requested to perform peritoneal scintigraphy.

Fig. 1.

a) Posteroanterior chest X-ray showing increased radiation density in right hemithorax consistent with massive pleural effusion; b) peritoneal scintigraphy showing rapid diffusion of the radiotracer from the peritoneal cavity to the right hemitorax, which is most obvious in static images acquired in posterior projection after 60 min. This image is consistent with pleuroperitoneal fistula.

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After injection of 99mTc-phytate into the dialysis fluid, radiopharmaceutical diffusion from the peritoneal cavity to the right pleural cavity, consistent with pleuroperitoneal fistula, occurred in the third minute (Fig. 1b, red arrow). Given the speed and intensity of the diffusion, the peritoneal catheter was removed, and the patient was switched to the final step of hemodialysis.

Pleural effusion is a rare complication in patients receiving peritoneal dialysis (2%). It may be caused by congenital diaphragmatic defects, but also by an increase in intra-abdominal pressures due to PD itself.1 Peritoneal scintigraphy is a simple, non-invasive technique that determines the existence and intensity of the pleuroperitoneal leak, with the aim of offering patients the most appropriate treatment.2

Acknowledgements

The authors are grateful for the collaboration of all the staff of the Nuclear Medicine Department of the Virgen del Rocío University Hospital.

References
[1]
K. Chawla, A. Shah, L. Pawar, K. Soltanpour, S. Zaidi.
Chronic pleural effusions secondary to peritoneal dialysis.
Chest, 150 Suppl 587A (2016),
[2]
L.F. León Ramirez, C. Riola Parada, A. Ortega Candil, E. Cala Zuluaga, A. Serrano Palacio, L. Lapeña Gutiérrez, et al.
Comunicación peritoneo-pleural en paciente en diálisis peritoneal confirmada mediante gammagrafía peritoneal con 99mTc macroagregados de albúmina.
NefroPlus, 9 (2017), pp. 98-99

Please cite this article as: Martin-Marcuartu JJ, Fernández-Rodríguez P, Tirado-Hospital JL. Gammagrafía peritoneal en el diagnóstico de la comunicación peritoneo-pleural. Arch Bronconeumol. 2020;56:524.

Copyright © 2019. SEPAR
Archivos de Bronconeumología

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