Around 5% of patients receiving renal replacement therapy in Spain are on peritoneal dialysis. Anatomical integrity of the peritoneum is essential since increased hydrostatic pressure due to peritoneal accumulation of dialysis fluid predisposes to abdominal or pelvic hernias or chest leakage via the embryonic pneumatoenteric recess.1
We report the case of a 3-year-old girl with a history of Finnish-type congenital nephrotic syndrome, receiving post-nephrectomy peritoneal dialysis since the age of 2. Fourteen months after starting peritoneal dialysis, she was admitted to our hospital due to severe dyspnea, with massive right hydrothorax on chest X-ray. To rule out pleuroperitoneal leak, a peritoneal scintigraphy was performed during dialysis after instillation of 37MBq of 99mTc-sulfur colloid in 450cc of dialysis solution (upper image), which was negative for pleuroperitoneal communication. One month later, after readmission for respiratory distress, hypoventilation, and right hydrothorax, isotopic peritoneography was repeated (lower image), and found to be positive after administration of 125cc of dialysis solution. On this basis, the patient was transferred definitively to hemodialysis (Fig. 1).
Peritoneal scintigraphy negative for pleuroperitoneal communication. Anterior projections obtained at 15, 60, and 120min (upper image). Peritoneal scintigraphy positive for pleuroperitoneal leak. Anterior projections obtained after 50, 125, and 500ml of peritoneal dialysis solution (lower image).
We demonstrate the utility of isotopic peritoneography as a non-invasive, safe, and simple method of detecting pleuroperitoneal leaks in patients undergoing peritoneal dialysis.2
FundingThe authors state that they received no funding.
Conflict of InterestThe authors state that they have no conflict of interests.
Please cite this article as: García Gómez FJ, Martínez Esteve A, Tirado Hospital JL. Diagnóstico de comunicación peritoneo-pleural mediante peritoneograma isotópico con 99mTc-sulfuro coloidal en una niña de 3 años con síndrome nefrótico congénito tipo finlandés. Arch Bronconeumol. 2015;51:199–200.
