Modalities for the diagnosis of abdominal and thoracic cavity defects in peritoneal dialysis patients
- Madhukar Misra, MD, FRCP
Madhukar Misra, MD, FRCP
- Professor of Medicine
- University of Missouri School of Medicine, Columbia
The presence of dialysis fluid in the abdominal cavity increases intra-abdominal pressure and may lead to the dialysis fluid leaking from acquired or congenital defects in the abdominal and thoracic wall. This may manifest as hydrothorax, hernia, or genital/abdominal wall edema. (See "Noninfectious complications of peritoneal dialysis catheters" and "Noninfectious complications of continuous peritoneal dialysis" and "Abdominal hernias in continuous peritoneal dialysis".)
Various diagnostic modalities were previously used to help diagnose these defects. In the 1970s, plain radiographs, contrast catheterograms, and peritoneographs were commonly utilized. However, since they were somewhat inaccurate and misleading , these techniques have been replaced by radiologic methods. These newer methods include nuclear isotope scans (peritoneal scintigraphy), computed tomography scans (CTS; CT peritoneography [CTP]), and magnetic resonance imaging (MRI; MR peritoneography [MRP]) using contrast/dye materials.
This topic review will discuss the diagnostic methods used to detect defects in the abdominal and thoracic wall among patients undergoing peritoneal dialysis. A review of general problems among peritoneal dialysis patients, including the clinical manifestations suggestive of a hernia or peritoneal and/or pleural leak, is presented separately. (See "Noninfectious complications of peritoneal dialysis catheters".)
Peritoneal scintigraphy is a safe, accurate, and rapid way of diagnosing leaks in the peritoneal cavity [2-5]. Three to 5 millicuries of technetium 99m isotope per 0.5 to 2.0 L of dialysis solution is injected into the abdominal cavity. Multiple projections (anterior, lateral, posterior, and oblique) are then taken to help separate a leak in the abdominal wall from the peritoneal fluid posterior to it .
Although a significant dose of isotope is used, it is not absorbed from the peritoneum, and almost all of the material drains out of the body after the procedure. The net dose of radiation is therefore only a fraction of the total dose instilled into the peritoneal cavity .
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