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Role of nuclear medicine in the diagnosis of peritoneal leaks in patients in dialysis: Experience of Hospital Universitario Son Espases
Papel de la medicina nuclear en el diagnóstico de fugas peritoneales en pacientes en diálisis: experiencia del Hospital Universitario Son Espases
Jaime Amayaa,
Corresponding author
jaimeamayasaumet@gmail.com

Corresponding author.
, Sebastià Rubía,b, María Munarc, José Luis Garcíac, Celia Medinaa, Belén Lunaa, Catalina Sampola,b, Cristina Peñaa,b
a Servicio de Medicina Nuclear, Hospital Universitario Son Espases, Palma de Mallorca, Spain
b Instituto de Investigación Sanitaria Illes Balears (IdISBa), Islas Baleares, Spain
c Servicio de Nefrología (Sección Diálisis), Hospital Universitario Son Espases, Palma de Mallorca, Spain
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          "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">A&#58; PFL towards the right inguinal canal&#46; In the SPECT-CT study&#44; the absence of migration to the scrotal sack is verified B&#58; inguinoscrotal PFL&#44; with the tracer passing to the testicles and scrotal sack bilaterally&#46;</p>"
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    "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Peritoneal dialysis &#40;PD&#41; is a treatment option in patients with chronic kidney disease &#40;CKD&#41;&#44; offering multiple advantages over haemodialysis&#44; although it is not without complications&#46;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> Among these&#44; peritoneal fluid leak &#40;PFL&#41; to other compartments stands out&#46; Despite being the technique of choice for diagnosing leaks&#44; peritoneal scintigraphy &#40;PS&#41; has fallen into disuse&#44; probably due to lack of knowledge on the part of emerging specialists and the availability of other techniques&#46;<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0010" class="elsevierStylePara elsevierViewall">We present a series of images of the most representative cases of all the PS procedures performed at our hospital&#44; from 2014 to the present&#44; where we have performed a total of 19 procedures in 16 PD patients with CKD and suspected PFL&#44; using the acquisition of static images in supine decubitus of the thoracic and abdominal&#47;pelvic region after intraperitoneal administration of &#91;<span class="elsevierStyleSup">99m</span>Tc&#93; Tc-nanocolloid in the dialysis solution&#44; post-Trendelenburg of 5&#8239;min duration&#44; and after evacuation of the labelled peritoneal solution&#44; approximately 60&#8239;min post-administration&#46; Single-photon emission computed tomography with computed tomography &#40;SPECT-CT&#41; was performed in three of them&#46;</p><p id="par0015" class="elsevierStylePara elsevierViewall">A total of 13 PFLs were diagnosed&#58; two inguinal &#40;<a class="elsevierStyleCrossRef" href="#fig0005">Fig&#46; 1</a>&#41;&#44; one subcutaneous &#40;<a class="elsevierStyleCrossRef" href="#fig0010">Fig&#46; 2</a>&#41; and 11 pleural &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46; Of these&#44; 53&#37; were kept on peritoneal repose for 3&#8211;4 weeks&#44; requiring temporary haemodialysis in a few cases&#44; as well as radiographic and analytical follow-up tests&#44; with subsequent resumption of PD &#40;three patients required pleurodesis&#41;&#44; while 38&#37; of them made a direct transition to haemodialysis PFL was not diagnosed in 3&#37; and they continued PD without presenting other complications&#46; Incidentally&#44; migration of the tracer to thoracic&#47;mediastinal lymph nodes was observed in six of the 16 patients &#40;&#8220;hotspots&#8221;&#41;&#44; with no clear pathological significance &#40;<a class="elsevierStyleCrossRef" href="#fig0015">Fig&#46; 3</a>&#41;&#46;</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><elsevierMultimedia ident="fig0015"></elsevierMultimedia><p id="par0020" class="elsevierStylePara elsevierViewall">The appearance of these aforementioned mediastinal lymph node &#8220;hotspots&#8221;&#44; not previously reported in other publications&#44; does not seem to be associated with PFL in the pleural cavity per se&#44; since this event was also seen in patients without a leak &#40;<a class="elsevierStyleCrossRef" href="#fig0020">Fig&#46; 4</a>&#41;&#46; Therefore&#44; these findings establish that the appearance of mediastinal foci constitutes a possible event that can be considered as a misleading image or &#8220;pitfall&#8221; of PS with &#91;<span class="elsevierStyleSup">99m</span>Tc&#93; Tc-nanocolloid&#44; which is probably attributed&#44; as in other procedures where this type of tracers are also used&#44; to the injection technique thereof&#46;</p><elsevierMultimedia ident="fig0020"></elsevierMultimedia><p id="par0025" class="elsevierStylePara elsevierViewall">In our experience&#44; PS has been shown to be a simple&#44; highly effective diagnostic tool with good accuracy for the diagnosis of PFL&#44; allowing PD therapy to be adapted or stopped&#44; positively impacting the quality of life of CKD patients on dialysis&#46;</p></span>"
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                    0 => array:2 [
                      "titulo" => "Utility of scintigraphy in assessment of noninfectious complications of peritoneal dialysis"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "G&#46; Choudhary"
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                        "tituloSerie" => "J Nucl Med Technol"
                        "fecha" => "2019"
                        "volumen" => "47"
                        "paginaInicial" => "163"
                        "paginaFinal" => "168"
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                    0 => array:2 [
                      "titulo" => "Utility of peritoneal scintigraphy in peritoneal dialysis patients&#58; one center experience"
                      "autores" => array:1 [
                        0 => array:2 [
                          "etal" => false
                          "autores" => array:3 [
                            0 => "R&#46; Haridian"
                            1 => "S&#46; Barrios"
                            2 => "M&#46; Rioja"
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                        ]
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                    ]
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                    0 => array:2 [
                      "doi" => "10.34067/KID.0000302020"
                      "Revista" => array:6 [
                        "tituloSerie" => "Kidney360"
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                        "volumen" => "1"
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Article information
ISSN: 20132514
Original language: English
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