Technetium-99m Pertechnetate imaging in the diagnosis of peritoneal leaks in peritoneal dialysis

Objectives This study illustrates Technetium-99m Pertechnetate, as the most accessible radio pharmaceutical, is feasible to be used in diagnosis peritoneal leaks in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) with suspected leakage of dialysate fluid from the peritoneal cavity.

Methods Fourteen patients with complaints of genital and/or inguinal edema or pleural effusion during undergoing CAPD were referred for peritoneal scintigraphy to confirm the existence of peritoneal leaks. The scintigraphic study was initiated by mixing 10.0 mCi of Technetium-99m pertechnetate in two liters of 1.5% dextrose peritoneal dialysis solution and then administered rapidly into the peritoneal cavity through the abdominal catheter. The dynamic and delay images were acquired to monitor the distribution of the fluid.

Results The patients were divided into two groups. Group 1, Eight patients with pleural effusion. Abnormal uptake was showed in the chest within 1-2 hours in six patients, confirming the presence of peritoneal diaphragmatic leakage. Two cases were diagnosed with the delay and lateral position images. Two of the eight patients, renal transplantation and diaphragm repair surgery were performed respectively. Pleural effusion decreased or disappeared in another six patients with modification the dialysis solution or switch to hemodialysis treatment. Group 2, In six patients with Groin and/or perineal edema, five patients showed intense activity accumulation extending to the groin or genital area, the presence of dialysate leakage were revealed. No obvious abnormal accumulation of radiotracer was observed in the genital area in 6-hour images in one patient. Hydrocele repair surgery in two cases, and four patients changed to intermittent or hemodialysis treatment, groin and genital edema was significantly reduced or disappeared.

Conclusions Nuclear peritoneal scintigraphy using Tc-99m Pertechnetate intraperitoneally can be employed successfully to demonstrate the peritoneal leaks, and aid clinicians in the decision making of the therapeutic approach to the complete problem