technetium-tc-99m-sulfur-colloid and Ascites

Topics: Antimony; Ascites; Breast Neoplasms; Colloids; Female; Gastrointestinal Neoplasms; Gold Colloid, Radioactive; Humans; Indium; Lung Neoplasms; Lymphoscintigraphy; Male; Melanoma; Mercury Radioisotopes; Methods; Neoplasm Staging; Organotechnetium Compounds; Ovarian Neoplasms; Phytic Acid; Prostatic Neoplasms; Radioisotopes; Sulfur; Technetium; Technetium Compounds; Technetium Tc 99m Sulfur Colloid

Pleural effusion in cirrhotic patients (hepatic hydrothorax) may result from migration of ascitic fluid across defects in the diaphragm. Biochemical analysis of ascitic and pleural fluid provides only indirect information about the nature and origin of the effusion. The present study was performed in order to demonstrate the presence/absence of peritoneo-pleural communication by radioisotope imaging.. Ten patients with cirrhotic ascites and pleural effusion were studied with 99mTc sulfur colloid scintigraphy to look for movement of the radiotracer from the peritoneal to the pleural cavity. Serum-ascitic albumin gradient (SAAG) and serum-pleural fluid albumin gradient (SPAG) values were determined in eight patients to examine the nature of the ascitic and pleural fluids.. Transdiaphragmatic movement of ascitic fluid into the pleural space was demonstrated (generally within 2 h of intraperitoneal injection of the radiotracer) in eight of 10 patients; six on the right side, one on the left and one bilaterally. Two patients in whom pleural fluid was transudative on SPAG values were negative for peritoneo-pleural communications.. Radionuclide scintigraphy is a simple, safe and relatively non-invasive method to confirm passage of ascitic fluid across the diaphragm.

Topics: Adult; Aged; Ascites; Diaphragm; Fibrosis; Humans; Male; Middle Aged; Peritoneum; Pleura; Pleural Effusion; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Ascites; Humans; Hydrothorax; Liver Cirrhosis; Male; Pleural Effusion; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

Hydrothorax is an infrequent but well-recognized complication in patients on continuous ambulatory peritoneal dialysis (CAPD) and patients with cirrhotic ascites. It is usually found on the right side; an incidence on both sides is rarely reported. We describe the scintigraphic diagnosis of unusual bilateral peritoneopleural communication in a patient with cirrhotic ascites.

Topics: Ascites; Female; Humans; Liver Cirrhosis; Middle Aged; Peritoneum; Pleura; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Aged; Aged, 80 and over; Ascites; Humans; Hydrothorax; Liver Cirrhosis, Alcoholic; Male; Pleural Effusion; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

To ascertain the frequency and to describe the clinical and biochemical features of cirrhotic chylothorax.. A descriptive clinical study.. A community teaching hospital.. Since November 1989 to October 1995, 809 patients with pleural effusions were studied by thoracentesis. Pleural effusions with a concentration of triglycerides higher than 110 mg/dL, a pleural fluid to serum triglyceride ratio higher than 1, and a pleural fluid to serum cholesterol ratio lower than 1 were considered chylothorax.. Twenty-four patients had pleural effusions that complied with all three aforementioned biochemical conditions. Five of these 24 patients (20%), were found to have liver cirrhosis as the main cause of chylothorax and in 3 of them, an abdominal source of the effusion could be demonstrated by intraperitoneal injection of a radioisotope (99mTc-sulfur colloid). The cirrhotic chylous effusions had significantly lower (p<0.005) protein (median, 1.7; range, 1.4 to 2.7 g/dL), lactate dehydrogenase (LDH) (median, 96; range, 77 to 138 IU/L), and cholesterol (median, 25; range, 22 to 64 mg/dL) levels than chylous effusions resulting from other causes (protein: median, 4.1; range, 1.7 to 6.8 g/dL; LDH: median, 351; range, 140 to 8,600 IU/L; and cholesterol: median, 87; range, 38 to 160 mg/dL). Cirrhotic chylothorax was always a transudate according to Light's criteria.. Chylothorax is a rare and apparently underappreciated manifestation of cirrhosis resulting from transdiaphragmatic passage of chylous ascites. Its uniform biochemical characteristics can facilitate its separation from chylous effusions of different etiology, therefore avoiding potentially harmful diagnostic and therapeutic procedures.

Topics: Adult; Aged; Aged, 80 and over; Ascites; Cholesterol; Chylothorax; Female; Follow-Up Studies; Humans; Incidence; Injections, Intraperitoneal; L-Lactate Dehydrogenase; Liver Cirrhosis; Male; Middle Aged; Paracentesis; Pleural Effusion; Proteins; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid; Triglycerides

Pleural effusion in the presence of cirrhosis and ascites is well recognized. Peritoneal fluid is thought to enter the pleural cavity either because of overloaded lymphatics or a structural defect between the peritoneal and chest cavities. Pleural effusion rarely occurs in the absence of demonstrable ascites. This report describes the scintigraphic diagnosis of peritoneo-pleural communication in a patient with cryptogenic cirrhosis and pleural effusion without ascites.

Topics: Ascites; Female; Humans; Liver Cirrhosis; Middle Aged; Peritoneal Cavity; Pleural Effusion; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon

Topics: Ascites; Humans; Kidney Failure, Chronic; Lymph; Male; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Pseudomonas aeruginosa; Pseudomonas Infections; Technetium Tc 99m Sulfur Colloid; Time Factors

Topics: Ascites; Female; Humans; Hydrothorax; Liver Cirrhosis; Middle Aged; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Patients with ascites are known to have complications such as pleural effusions and hernias. Special diagnostic procedures are occasionally necessary to determine the nature of the abnormality and to determine the corrective medico-surgical approach. The two cases described illustrate the usefulness of intraperitoneal as well as intrapleural injection of a radionuclide in diagnosing the leakage of ascitic fluid.

Topics: Adult; Ascites; Diaphragm; Female; Hernia, Ventral; Humans; Liver Diseases; Male; Middle Aged; Peritoneum; Pleura; Pleural Effusion; Radionuclide Imaging; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

An elderly obese male with a lengthy history of melanotic stools was admitted and was shown to have a posterior duodenal ulcer by endoscopy. He became obtunded and developed infected ascites. Because of his obesity, ascites, and inability to cooperate, the GI radiologist felt that a Gastrografin upper GI series would not be helpful. We therefore gave the patient 99mTc-labeled sulfur colloid and tap water through his nasogastric tube. We were able to clearly image a site of perforation at the duodenal bulb communicating with the lesser sac.

Topics: Aged; Ascites; Duodenal Ulcer; Duodenoscopy; Duodenum; Humans; Male; Melena; Peptic Ulcer Perforation; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

A 54-yr-old female with known liver cirrhosis presented with a right transudative pleural effusion and ascites. To find the source of pleural fluid, [99mTc]sulfur colloid was injected intraperitoneally and a serial imaging study revealed its passage to the right pleural space on 2-hr and 24-hr images. Mechanisms proposed in the formation of pleural effusion in liver cirrhosis are (a) lymphatic drainage and (b) diaphragmatic defect. Radioisotope migration speed may be a clue for differentiating these two mechanisms, being more rapid in the presence of a diaphragmatic defect.

Topics: Ascites; Female; Fistula; Humans; Liver Cirrhosis, Alcoholic; Middle Aged; Peritoneal Diseases; Pleural Diseases; Pleural Effusion; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Topics: Ascites; Ascitic Fluid; Diaphragm; Female; Humans; Ovarian Neoplasms; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A case report is presented in which malfunction of a peritoneovenous shunt was caused by subintimal dissection of the venous end of the shunt tubing. The radionuclide shunt patency study demonstrated a collection of radioactivity at the venous end of the tubing, representing the abnormal intramural collection of peritoneal fluid. Scintigraphic demonstration of this complication of a peritoneovenous shunt has not been reported previously.

Topics: Ascites; Graft Occlusion, Vascular; Humans; Male; Middle Aged; Peritoneovenous Shunt; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid; Vascular Surgical Procedures

Scintigraphic evidence of ascites has been observed in Tc-99m sulfur colloid studies of the liver and spleen, in Tc-99m HIDA hepatobiliary scans, in Ga-67 citrate scans, and in Tc-99m phosphonate bone images. Pleural effusion has been demonstrated in Tc-99m phosphonate bone scintigraphy. The case of a 48-year-old man whose Tc-99m sulfur colloid liver-spleen scintigram simultaneously demonstrated a right pleural effusion and ascites is presented.

Topics: Ascites; Humans; Liver; Liver Cirrhosis, Alcoholic; Male; Middle Aged; Pleural Effusion; Radionuclide Imaging; Spleen; Technetium Tc 99m Sulfur Colloid

Topics: Ascites; Female; Humans; Male; Methods; Middle Aged; Organotechnetium Compounds; Peritoneovenous Shunt; Radionuclide Imaging; Serum Albumin; Sugar Acids; Sulfur; Technetium; Technetium Compounds; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid; Tin; Tin Compounds; Vascular Surgical Procedures

Hydrothorax occurs in 5.3 percent of ascitic patients. Our experience with 22 cases forms the basis of this report. Of the 22 cases, 21 were spontaneous and 1 was due to transdiaphragmatic incision. Eighteen occurred on the right side. Usually fluid enters the chest through tiny defects in the diaphragm. These defects are often covered by pleuroperitoneum, but the high abdominal pressure raises a bleb on the superior surface of the diaphragm. Rupture produces hydrothorax. The ascites is often relieved with the onset of the hydrothorax. Blockage of the thoracic duct has produced chylous ascites. The thoracoabdominal communication is immediately confirmed by a scan of the chest and abdomen after intraperitoneal injection of technetium-99 colloid. Fluid is tapped from the chest immediately before intraperitoneal injection. The rate at which the technetium-99 enters the chest is related to the size of the defect in the diaphragm. A significant transfer should occur within 12 hours. Immediate transfer occurs with large defects. The ruptured blister on the diaphragm forms a one-way valve. Intrathoracic injection does not migrate into the peritoneal cavity. The valvular characteristics of the leak force ascitic fluid into the thorax because the differential pressure between the abdominal and pleural cavities is intensified by inspiration. If tension hydrothorax has occurred, urgent thoracocentesis and paracentesis may be required. A chest tube should not be introduced. The main principle of surgery is to supply a low resistance pathway for the return of fluid to the venous system and to eliminate the diaphragmatic defect by obliteration of the pleural space. A LeVeen peritoneovenous shunt is performed after emptying the abdomen of its fluid load. After completion of the shunt operation, the chest is emptied of fluid, and a sclerosing agent (tetracycline or nitrogen mustard) is injected into the pleural cavity. Closure of the defect is verified by technetium-99 labeled scans which also confirm shunt patency. With this regime, the defect closed or was rendered insignificant in 18 of 22 patients. One patient had a post-transdiaphragmatic surgical defect which was too extensive to be closed by the aforementioned procedures. One patient remained well but did not have closure of the defect, one patient with a ruptured hiatal hernia did not have closure, and one patient who had previous placement of a chest tube could not be closed. Therefore, 18 of 22 patients were su

Topics: Ascites; Drainage; Humans; Hydrothorax; Intubation; Peritoneovenous Shunt; Pleura; Sclerosing Solutions; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Tetracycline

Topics: Adult; Ascites; Female; Humans; Hydrothorax; Middle Aged; Peritoneovenous Shunt; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

False-positive radionuclide liver images can occur due to impingement on the liver by adjacent normal anatomic structures or adjacent pathologic masses or fluid collections. A patient with ascites in the anterior subphrenic space had an apparent "cold" lesion in the left lobe of the liver. Ultrasonography demonstrated a normal left lobe and localized the fluid collection.

Topics: Ascites; Diagnosis, Differential; False Positive Reactions; Humans; Liver; Liver Diseases; Male; Middle Aged; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Ultrasonography

Lymphoscintigraphy is an easily performed noninvasive procedure that offers the potential to detect small numbers of ascitic tumor cells and early diaphragmatic tumor involvement. Moreover, it can be used to delineate and define abnormalities in lymph nodes that are not routinely visualized by bipedal contrast lymphangiography, ultrasound or computed tomography. Lymphoscintigraphy is recommended as an important investigative and adjunctive procedure in diagnosing gynecologic malignancies; there does not appear to be sufficient sensitivity and specificity to justify its routine clinical use.

Topics: Animals; Ascites; Breast; Female; Humans; Lymph Nodes; Mediastinum; Mice; Ovarian Neoplasms; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Uterine Cervical Neoplasms; Uterine Neoplasms

The source of massive pleural effusion was not apparent in a 58-year-old man who had cirrhosis but no demonstrable ascites. Intraperitoneal injection of technetium Tc 99m sulfur colloid established the presence of peritoneopleural communication. This diagnostic technique can be helpful in evaluating patients with cirrhosis of the liver and pleural effusion with or without ascites.

Topics: Ascites; Humans; Liver Cirrhosis; Male; Middle Aged; Pleural Effusion; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

A patient with acute parenchymal liver disease whose Tc-99m sulfur colloid (SC) liver/spleen scan showed a perisplenic halo in the posterior view (supine position) proved to have mild ascites at the time of autopsy. The signs of mild and massive ascites are briefly discussed.

Topics: Aged; Ascites; Humans; Liver; Liver Diseases; Male; Radionuclide Imaging; Spleen; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Ascites; Ascitic Fluid; Female; Humans; Peritoneovenous Shunt; Pleural Effusion; Radiography; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid; Vascular Surgical Procedures

In an experimental model we have demonstrated that visualization of the target organ is the only dependable criterion for the scintigraphic evaluation of LeVeen shunt patency or nonpatency. The lungs are best suited as the target, because the presence or absence of pulmonary uptake can be easily seen without interference from radiolabeled peritoneal fluid. Proof of shunt patency should not rely upon direct visualization of shunt tubing, because very high or low flow rates are both associated with poor visualization. Maximum accumulation of activity in the shunt tubing occurs with intermediate flow rates (approximately 60 cc/hr).

Topics: Ascites; Colloids; Evaluation Studies as Topic; Female; Humans; Liver; Lung; Methods; Middle Aged; Peritoneal Cavity; Postoperative Complications; Radionuclide Imaging; Serum Albumin; Sulfur; Technetium; Technetium Tc 99m Aggregated Albumin; Technetium Tc 99m Sulfur Colloid

This case report illustrates the demonstration of pleural-peritoneal communication in a patient with a malfunctioning LeVeen shunt by a simple, noninvasive radionuclide technique. The patient was a 54-year-old woman who had had a LeVeen shunt placed for the treatment of intractable ascites. Tc-99m-sulfur colloid was injected intraperitoneally, and the scan showed concentration of the tracer in the pleural space, thus confirming pleural-peritoneal communication.

Topics: Ascites; Colloids; Female; Fistula; Humans; Middle Aged; Peritoneum; Pleural Diseases; Pleural Effusion; Postoperative Complications; Radiography; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid