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KMID : 0363819940280020234
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Korean Journal of Nuclear Medicine
1994 Volume.28 No. 2 p.234 ~ p.236
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Scintigraphic Demonstration of Peritoneopleural Communication
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Ham, Soo Youn
Choe, Jae Gol/Lee, Min Jae
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Abstract
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A 45 year old man was admitted for the initiation of continuous ambulatory peritoneal dialysis(CAPD). He was diagnosed as membranoproliferavive glomerulonephritis 5 years ago by renal biopsy. At the time of his admission, his serum creatinine level was elevated to 9.9 mg/dl and blood urea nitrogen was 42 mg/dl. 24 hours after starting the CAPD, he complained of sudden onset of dyspnea. Physical examination and plain chest radiograph revealed massive right pleural effusion(Fig. 1). Immediately thoracenthesis was done. The content of glucose of the pleural effusion was 250 mg/dl, which was higher as compared with the serum level( 127mg/dl). The protein concentration and leukocyte count of pleural fluid were lower than those of the serum level.
To demonstrate the possible communication between peritoneal and pleural cavities, scintigraphic study was done by peritoneal injection of 20 mCi Tc99m sulfur colloid through the CAPD cathter. The patient was placed in a decubitus position in front of the gamma camera. After the injection of the radiopharmaceutical through the catheter, the first set of dynamic images was taken every 30 sec for 10 minutes in posterior projection.
The dynamic scans show some migration of radioactivies in the right hemthorax from` the peritoneal cavity(Fig. 2). The second set of dynamic images was taken during infusion of 1 liter of Peritosol (Boryong, Korea). And there noted remakable increase in radioactivity in the whole right hemithorax (Fig. 3). This phenomenon is more apparent in the delayed static images(Fig. 4). On the 7th day of admission, he underwent pleurodesis with tetracycline.
Massive hydrothorax during peritoneal dialysis is rare complication occurring from 3 % to 6%", during CAPD. The development of massive hydrothorax cor
relates with the diaphragmatic defect or the di phragmatic lymphatic chain´"). The diagnostic wo up includes the analysis of pleural effusion to meam sure the content of glucose, protein and leukoc count. When the difference is moderate, it is diffic to determine whether it comes from the dialysate;´ the pritoneal cavity or not, especially in the patien with diabetes mellitus. To demonstrate the source` the pleural effusion, scintigraphic study can be do by intraperitoneal injection of the radioisotope su as Tc-99m sulfur colloid or Tc-99m macroa gated albumin(MAA). The radioisotope study is co sidered to be the method of choice because it noninvasive and exposes small dose of radiation´-´ And it can be done as a dynamic mode.
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