sodium-pertechnetate-tc-99m and Pleural-Effusion

A large left-sided pleural effusion occurred in a 12-year-old end-stage renal disease patient undergoing chronic hemodialysis (HD). The fluid had physical and laboratory characteristics of chylothorax (CHTX) and was probably related to the multiple HD accesses placed in the neck area. Initially, thoracenteses were performed and the fluid discarded. Subsequently, a permanent drainage catheter placed in the left hemithorax was connected to a syringe with a stopcock, and from here to the arterial port of the HD catheter. One liter of CHTX fluid was removed on dialysis days three times weekly, for 7.5 weeks, and directly re-infused into the patient in a closed sterile circuit. A total of about 20 l was safely returned to the patient. The procedure was well tolerated and provided time until the CHTX resolved spontaneously. It is recommended that in similar clinical settings re-infusion of CHTX fluid should be performed to prevent the loss of protein-/T-cell-rich fluid.

Topics: Body Fluids; Catheters, Indwelling; Child; Chylothorax; Drainage; Humans; Kidney Failure, Chronic; Lymphography; Male; Neck; Pleural Effusion; Radiopharmaceuticals; Renal Dialysis; Sodium Pertechnetate Tc 99m; Vena Cava, Superior

A woman with a history of multiple drug allergies was admitted for cough and dyspnea. She had been taking nitrofurantoin for 10 days, was febrile, and had a rash on the trunk and extremities. A chest radiograph revealed right-sided pleural effusion and basal markings. Because of suspected nitrofurantoin-related pulmonary reaction, the medication was discontinued and the patient was started on an H2-blocker and intravenous corticosteroids. She improved clinically, and within 24 hours a radiograph revealed that her chest had largely cleared. Restricted distribution of radioxenon, seen initially on a ventilation lung scan, also reverted to near normal by the follow-up. The first perfusion lung scan showed multiple but nonspecific changes; this also came back to near normal. The nitrofurantoin-related pulmonary reaction should be considered in patients who present with pulmonary signs/symptoms while on the medication.

Topics: Drug Hypersensitivity; Female; Humans; Lung; Middle Aged; Nitrofurantoin; Pleural Effusion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m; Urinary Tract Infections; Ventilation-Perfusion Ratio; Xenon Radioisotopes

Thoracostomy tube drainage with tetracycline (TCN) instillation is an effective technique for management of recurrent, symptomatic, malignant pleural effusions. Although patient rotation through various positions after instillation of TCN has been advocated empirically, it has not been shown scientifically to be necessary and is often uncomfortable for the patient and time-consuming for personnel. Five patients with symptomatic, malignant pleural effusions were studied during pleurodesis using radiolabelled TCN. Scintigraphic imaging was done immediately after TCN instillation prior to patient rotation. Patients were rotated through six positions and multiple images were obtained at 30 and 120 minutes. Tetracycline dispersed throughout the pleural space within seconds. Patient positioning had no effect on the intrapleural distribution of TCN in four of the five patients. In one patient with loculated hydropneumothorax and trapped lung, rotation minimally improved distribution of TCN to the apex. Rotation during pleurodesis does not appear to be necessary in patients with a relatively normal pleural space. However, patient rotation enhances distribution of TCN when the lung is separated substantially from the chest wall, as with trapped lung. Possibly, in this situation the properties of fluid mechanics and capillary action no longer apply.

Topics: Adult; Aged; Humans; Middle Aged; Pleura; Pleural Effusion; Posture; Radionuclide Imaging; Recurrence; Sodium Pertechnetate Tc 99m; Tetracycline; Thoracostomy; Tissue Distribution

Topics: Humans; Pericardial Effusion; Pericardium; Pleural Effusion; Radionuclide Imaging; Sodium Pertechnetate Tc 99m