Hydrothorax in continuous ambulatory peritoneal dialysis: therapeutic implications of Tc-99m MAA peritoneal scintigraphy

Thoracocentesis helps diagnose diaphragmatic defects in peritoneal dialysis patients

“…The diagnosis of PD-related hydrothorax is at times elusive. Chemical analysis of the pleural fluid often shows it to be a transudate with a high glucose level (higher than serum but lower than dialysate), low protein concentration (less than 1 g/dl), and lower LDH level than simultaneously drawn serum [4,5,6]. In our patient, we were unable to confirm our clinical suspicion of PD-related hydrothorax using conventional techniques.…”

“…PD fluid chemistry showed that the protein was 284 mg/dl, glucose was 759 mg/dl, and LDH was 333 U/l. An isotopic peritoneogram was performed using 29.6 MBq (equivalent to 800 µCi) of technetium pertechnetate mixed with 500 ml of peritoneal dialysis fluid and instilled into the peritoneal cavity [5]. The estimated absorbed radiation dose to an average-sized adult patient from such a procedure is: whole body 0.11, bladder 0.42, ovaries 0.18, and thyroid 1.04 mGy.…”

“…Hydrothorax is more common on the right side of the chest [3,4]. In patients on PD, hydrothorax is often secondary to communication between the peritoneal cavity and pleural space [5]. Isotopic peritoneogram is commonly used to demonstrate defects in the diaphragm.…”

Mechanical Complications of Peritoneal Dialysis

“…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.…”

Opinion: What Unique Acid‐Base Considerations Exist in Dialysis Patients?

“…There is one other peritoneal dialysis‐specific complication to consider. Hydrothorax is known to occur in approximately 1.6% of continuous ambulatory peritoneal dialysis (CAPD) patients (23). The presence of a high glucose concentration and low protein content in the pleural fluid is strongly suggestive of a “leak” across the diaphragm.…”