Nephrology Image: SPECT/CT to diagnose pleuroperitoneal communication-associated hydrothorax in peritoneal dialysis

A 19-year-old man with end-stage renal failure secondary to bilateral hypoplastic kidney received nightly automated peritoneal dialysis (PD). Three months after starting PD, he complained of dyspnea. Chest X-ray showed right-sided pleural effusion (Figure 1). Congestive cardiac failure, hypoalbuminemia, and fluid overload were ruled out, so pleuroperitoneal communication (PPC) was suspected. Peritoneal scintigraphy with Tc-99m macro-aggregated albumin was performed. Simultaneously, single-photon-emission computed tomography and computed tomography (SPECT/CT) was performed to identify the leakage site using a hybrid system (BrightView XCT; Philips Medical Systems, Cleveland, OH). Radioactive tracer presence in the right hemithorax indicated the existence of PPC, with the right posterior diaphragm suggested as the presumptive leakage site (Figure 2). Nightly automated PD was suspended, and daytime PD was done at low volumes without worsening symptoms until living related renal transplantation was performed.