Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Modalities for the diagnosis of abdominal and thoracic cavity defects in peritoneal dialysis patients

Madhukar Misra, MD, FRCP
Section Editor
Steve J Schwab, MD
Deputy Editor
Alice M Sheridan, MD


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 However, since they were somewhat inaccurate and misleading [1], these techniques have been replaced by radiologic methods.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 [6].

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 [7].

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Sep 18, 2017.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Singal K, Segel DP, Bruns FJ, et al. Genital edema in patients on continuous ambulatory peritoneal dialysis. Report of 3 cases and review of the literature. Am J Nephrol 1986; 6:471.
  2. Juergensen PH, Rizvi H, Caride VJ, et al. Value of scintigraphy in chronic peritoneal dialysis patients. Kidney Int 1999; 55:1111.
  3. Walker JV, Fish MB. Scintigraphic detection of abdominal wall and diaphragmatic peritoneal leaks in patients on continuous ambulatory peritoneal dialysis. J Nucl Med 1988; 29:1596.
  4. Goh AS, Lee GS, Kee SG, et al. Radionuclide detection of dialysate leakage in patients on continuous ambulatory peritoneal dialysis. Ann Acad Med Singapore 1994; 23:315.
  5. Johnson J, Baum S, Smink RD Jr. Radionuclide imaging in the diagnosis of hernias related to peritoneal dialysis. Arch Surg 1987; 122:952.
  6. Berman C, Velchik MG, Shusterman N, Alavi A. The clinical utility of the Tc-99m SC intraperitoneal scan in CAPD patients. Clin Nucl Med 1989; 14:405.
  7. Johnson BF, Segasby CA, Holroyd AM, et al. A method for demonstrating subclinical inguinal herniae in patients undergoing peritoneal dialysis: the isotope 'peritoneoscrotogram'. Nephrol Dial Transplant 1987; 2:254.
  8. Leak LV, Rahil K. Permeability of the diaphragmatic mesothelium: the ultrastructural basis for "stomata". Am J Anat 1978; 151:557.
  9. Twardowski ZJ, Tully RJ, Ersoy FF, Dedhia NM. Computerized tomography with and without intraperitoneal contrast for determination of intraabdominal fluid distribution and diagnosis of complications in peritoneal dialysis patients. ASAIO Trans 1990; 36:95.
  10. Sissons GR, Jones SM, Evans C, Richards AR. Scintigraphic detection of abdominal hernias associated with continuous ambulatory peritoneal dialysis. Br J Radiol 1991; 64:1158.
  11. Gudit S, Sudhakar P, Ram R, et al. Peritoneal scintigraphy in the diagnosis of adhesions. Perit Dial Int 2010; 30:112.
  12. Hollett MD, Marn CS, Ellis JH, et al. Complications of continuous ambulatory peritoneal dialysis: evaluation with CT peritoneography. AJR Am J Roentgenol 1992; 159:983.
  13. Lam MF, Lo WK, Chu FS, et al. Retroperitoneal leakage as a cause of ultrafiltration failure. Perit Dial Int 2004; 24:466.
  14. Prokesch RW, Schima W, Schober E, et al. Complications of continuous ambulatory peritoneal dialysis: findings on MR peritoneography. AJR Am J Roentgenol 2000; 174:987.
  15. Arbeiter KM, Aufricht C, Mueller T, et al. MRI in the diagnosis of a peritoneal leak in continuous ambulatory peritoneal dialysis. Pediatr Radiol 2001; 31:745.
  16. Prischl FC, Muhr T, Seiringer EM, et al. Magnetic resonance imaging of the peritoneal cavity among peritoneal dialysis patients, using the dialysate as "contrast medium". J Am Soc Nephrol 2002; 13:197.
  17. Tang S, Chui WH, Tang AW, et al. Video-assisted thoracoscopic talc pleurodesis is effective for maintenance of peritoneal dialysis in acute hydrothorax complicating peritoneal dialysis. Nephrol Dial Transplant 2003; 18:804.
  18. Benz RL, Schleifer CR. Hydrothorax in continuous ambulatory peritoneal dialysis: successful treatment with intrapleural tetracycline and a review of the literature. Am J Kidney Dis 1985; 5:136.
  19. O'Sullivan JC. Letter: Female sterility produced by investigation. Br Med J 1973; 4:490.
  20. Camilleri B, Glancey G, Pledger D, Williams P. The icodextrin black line sign to confirm a pleural leak in a patient on peritoneal dialysis. Perit Dial Int 2004; 24:197.