Case Author(s): Randal Anderson, MD and Jerold Wallis, MD , 8/08/03 . Rating: #D3, #Q5
Diagnosis: Diaphragmatic leak
Brief history:
49 year-old man with end-stage renal disease from Wegener's, on peritoneal dialysis.
Images:
pre-thoracentesis
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View third image(mc).
scintigraphy
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chest scintigraphy images only with different windowing
Full history/Diagnosis is available below
Diagnosis: Diaphragmatic leak
Full history:
Patient undergoing peritoneal dialysis, with recurrent pleural effusion.
Radiopharmaceutical:
Tc-99m Sulfur Colloid, intraperitoneal
Findings:
Good dispersion of tracer in the abdomen is seen. There is also increasing tracer activity in the right pleural space. Tracer in the thoracentesis catheter can also be seen.
Discussion:
In cases of suspected diaphragmatic tears or holes, free flow of fluid from the peritoneum into the pleural space can be documented by administering Tc-99m Sulfur Colloid into the peritoneum.
Followup:
The patient was switched to hemodialysis. A chest tube was placed, and pleurodesis was performed. The patient may return to peritoneal dialysis in the future if the scarring from the pleurodesis seals the diaphragmatic leak.
ACR Codes and Keywords:
References and General Discussion of (Anatomic field:Lung, Mediastinum, and Pleura, Category:Misc)
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Case number: mc002
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