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Acta Radiológica Portuguesa

versão impressa ISSN 2183-1351

Acta Radiol Port vol.33 no.1 Lisboa abr. 2021  Epub 16-Jul-2021

https://doi.org/10.25748/arp.21666 

Imagens de Interesse

Peritoneal Scintigraphy for Assessment of Pleuroperitoneal Communication

Cintigrafia Peritoneal na Avaliação de Comunicação Pleuroperitoneal

Adriana Sá Pinto1 
http://orcid.org/0000-0002-4210-5914

Rita Vicente2 
http://orcid.org/0000-0003-2726-9539

Nicole Pestana3 

Patrícia Gouveia1 

Ricardo Teixeira1 
http://orcid.org/0000-0002-8187-1419

11Serviço de Medicina Nuclear, Centro Hospitalar e Universitário do Porto, Porto, Portugal

22Serviço de Nefrologia, Hospital Espírito Santo de Évora, Évora, Portugal

33Serviço de Nefrologia, Centro Hospitalar do Funchal, Funchal, Portugal


Abstract

A 19-year-old woman with chronic kidney disease (stage 5D), under peritoneal dialysis, was suspected of pleuroperitoneal communication. Peritoneal scintigraphy confirmed the diagnosis and the patient was transferred to hemodialysis.

Keywords: C3 glomerulopathy; Pleuroperitoneal communication; Peritoneal scintigraphy.

Resumo

Mulher de 19 anos com doença renal crónica estadio 5D, sob diálise peritoneal, apresenta suspeita de comunicação pleuroperitoneal. Solicitada cintigrafia peritoneal para confirmação do diagnóstico, tendo sido a doente transferida para hemodiálise.

Palavras-chave: Glomerulopatia C3; Comunicação pleuroperitoneal; Cintigrafia peritoneal.

A 19-year-old woman with chronic kidney disease (stage 5D, secondary to C3 glomerulopathy), under peritoneal dialysis since May 2019, presented with retrosternal pain and dyspnea during a Nephrology appointment. Chest radiography revealed right pleural effusion of moderate/ large volume.

The patient had been recently submitted to thoracocentesis.

The pleural fluid was a transudate with a glucose concentration of 200 mg/dL, which raised the suspicion of pleuroperitoneal communication. To confirm the diagnosis a peritoneal scintigraphy was requested.

An intraperitoneal injection of 185 MBq of (99mTc) Tc-macroaggregated albumin was performed via the Tenckhoff catheter, along with the instillation of dialytic solution (2.3% glucose). Thoracic and abdominal static images were acquired 5 hours after the administration of the radiopharmaceutical in anterior (A), posterior (B) and lateral right (C) and left (D) views. In our department there are no SPECT-CT facilities, so a (99mTc) Tc-pertechnetate mark was placed at xiphoid process to help anatomy location (black arrow)(Fig. 1).

Peritoneal scintigraphy demonstrated leakage of peritoneal fluid into the right pleural cavity, with no abnormal tracer accumulation detected in the left hemithorax, thereby confirming a right pleuroperitoneal communication. The patient was transferred to hemodialysis. 1,2,3,4

References

1. Choudhary G, Manapragada P, Wallace E, Bhambhvani P. Utility of scintigraphy in assessment of noninfectious complications of peritoneal dialysis. J Nucl Med Technol. 2019;47:163-168. [ Links ]

2. Kennedy C, McCarthy C, Alken S, McWilliams J, Morgan RK, Denton M, Conlon PJ, Magee C. Pleuroperitoneal leak complicating peritoneal dialysis: a case series. Int J Nephrol. 2011;2011:526753. [ Links ]

3. Tokmak H, Mudun A, Türkmen C, Sanli Y, Cantez S, Bozfakioğlu S. The role of peritoneal scintigraphy in the detection of continuous ambulatory peritoneal dialysis complications. Ren Fail. 2006;28:709-13. [ Links ]

4. Ziessman HA, O’Malley JP. Gastrointestinal system. Nuclear medicine: the requisites. Elsevier Health Sciences. 2013;320. [ Links ]

Ethical disclosures

Financing Support: This work has not received any contribution, grant or scholarship.

Received: December 06, 2020; Accepted: January 17, 2021

Address Adriana Sá Pinto Serviço de Medicina Nuclear, Centro Hospitalar e Universitário do Porto, Largo do Prof. Abel Salazar, 4099-001, Porto, Portugal e-mail: adriana.aslpinto@gmail.com

Licence © Author(s) (or their employer(s)) and ARP 2021. Re-use permitted under CC BY-NC. No commercial re-use.

Conflicts of interest: The authors have no conflicts of interest to declare.

Confidentiality of data: The authors declare that they have followed the protocols of their work center on the publication of data from patients.

Protection of human and animal subjects: The authors declare that the procedures followed were in accordance with the regulations of the relevant clinical research ethics committee and with those of the Code of Ethics of the World Medical Association (Declaration of Helsinki).

Creative Commons License This is an open-access article distributed under the terms of the Creative Commons Attribution License