technetium-tc-99m-sulfur-colloid and Pleural-Effusion

Massive hydrothorax occurring during continuous ambulatory peritoneal dialysis is a rare complication that may appear at any time during the course of the treatment. Most of the time, it is right-sided and is more frequent in female patients. A case is presented that was investigated by peritoneopleural scintigraphy. A rapid accumulation of the radiopharmaceutical over the right hemithorax was observed. To explain that finding, a macroscopic diaphragmatic defect was suspected. Different therapeutic approaches are presented.

Topics: Female; Humans; Hydrothorax; Middle Aged; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Pleura; Pleural Effusion; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

A 7-month-old girl with history of persistent left chylous pleural effusion was referred for lymphoscintigraphy. A previous chest computed tomography (CT) scan demonstrated a small to moderate-sized left pleural effusion but could not identify the lymphatic leakage site. Lymphoscintigraphy using filtered (99m)Tc sulfur colloid showed minimal focal activity in the lower chest. A correlative single-photon emission computed tomography (SPECT)/CT localized this activity to distal paraesophageal region, being highly suggestive of the site of lymphatic leakage. Subsequent lymphangiography confirmed these findings, revealing an abnormal lymphatic branch at the level of T10 and T11 vertebrae with retrocrural extravasation toward the left hemithorax. Thoracic duct embolization was accomplished at and proximal to the site of chyle leak using a platinum coil and n-Butyl cyanoacrylate glue. The patient was followed up for >24 months and demonstrated no recurrence of pleural effusion. No ascites or other complications related to the procedure were noted. The case demonstrates that (99m)Tc sulfur colloid lymphoscintigraphy SPECT/CT can be a useful modality for detecting the chyle leakage site in children with chylothorax even when the amount of leakage is minimal.

Topics: Chyle; Chylothorax; Female; Humans; Infant; Lymphoscintigraphy; Pleural Effusion; Technetium Tc 99m Sulfur Colloid; Tomography, Emission-Computed, Single-Photon; Tomography, X-Ray Computed

Topics: Aged; Dyspnea; Female; Fibrosis; Humans; Peritoneovenous Shunt; Peritoneum; Pleural Effusion; Polycythemia Vera; Radionuclide Imaging; Radiopharmaceuticals; 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

Topics: Female; Humans; Kidney Failure, Chronic; Middle Aged; Peritoneal Dialysis, Continuous Ambulatory; Pleural Effusion; Radionuclide Imaging; Radiopharmaceuticals; Technetium Tc 99m Sulfur Colloid

This study investigated the incidence of subclinical abdominal hernia in patients starting peritoneal dialysis (PD). From April 1995 to August 1999, every new patient without clinical evidence of abdominal leakage underwent peritoneal scintigraphy. A total of 59 patients were enrolled in the study. Imaging of the peritoneal cavity was performed by mixing 74 MBq (2 mCi) of 99 m technetium sulfur colloid with 2 L of 1.36% dextrose peritoneal dialysis solution. Sequential gamma camera static images were obtained at 0 minutes, 60 minutes, and after drainage. Ten abdominal hernias (2 diaphragmatic leaks, 8 inguinal hernias) were observed in ten patients (6 males, 4 females; mean age: 65.1 years). One patient with diaphragmatic leak recovered partial renal function and stopped continuous ambulatory peritoneal dialysis (CAPD); the other was switched to automated peritoneal dialysis (APD). Among the eight patients with inguinal hernia, six had no clinical manifestations within eight months of follow-up. Two patients became symptomatic at 15 months and 25 months respectively. They underwent surgical repair. In CAPD patients without obvious abdominal hernias, peritoneal scintigraphy at onset of dialysis discovered 17% positive cases. The technique of scintigraphy is safe, with a low radiation exposure. Surgical repair for maintenance on CAPD is not always necessary, and a change in the PD strategy may be useful.

Topics: Adult; Aged; Aged, 80 and over; Female; Hernia, Ventral; Humans; Male; Middle Aged; Peritoneal Cavity; Peritoneal Dialysis, Continuous Ambulatory; Pleural Effusion; Radionuclide Imaging; Radiopharmaceuticals; 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

A patient with postoperative Stage I ovarian carcinoma received 15 mCi of 32P-chromic phosphate suspension in normal saline intraperitoneally as part of her therapy. The following day, a portion of the infused radiopharmaceutical and normal saline had passed transdiaphragmatically into the patient's right pleural cavity. Thoracentesis removed as much fluid as possible and this fluid contained radioactive material. In the ensuing 4 yr, the patient has not manifested any detectable pleural or pulmonary abnormalities attributable to the radioactivity. Retrospective review of 100 consecutive patients receiving 32P-chromic phosphate intraperitoneal therapy resulted in 43 patients in whom the hemithoraces could be evaluated scintigraphically. Three of the 43 patients (7%) had right pleural fluid radioactivity. This is similar to the percentages reported in patients with cirrhosis with ascites in whom hepatic hydrothorax is identified.

Topics: Chromium Compounds; Extravasation of Diagnostic and Therapeutic Materials; Female; Humans; Infusions, Parenteral; Middle Aged; Ovarian Neoplasms; Peritoneal Cavity; Phosphates; Phosphorus Radioisotopes; Pleura; Pleural Effusion; Technetium Tc 99m Sulfur Colloid; Time Factors; Tissue Distribution

The occurrence of extramedullary hematopoiesis in the pleura is rare and is usually asymptomatic. It is generally diagnosed on postmortem examination. Herein we describe a 61-year-old woman with agnogenic myeloid metaplasia who sought medical assessment because of progressive dyspnea. Thoracentesis yielded sanguineous fluid with 10% myeloblasts. A 99mTc bone marrow scan demonstrated increased tracer activity throughout both lungs, an outcome consistent with extramedullary hematopoiesis. Fine-needle aspiration and video-assisted thoracoscopy were considered but deferred because of the potential risk of profuse bleeding. Treatment with low-dose external beam irradiation to the left posterior pleura was successful. To date, no hemothorax has recurred.

Topics: Female; Hematopoiesis, Extramedullary; Humans; Middle Aged; Pleura; Pleural Effusion; Primary Myelofibrosis; Technetium Tc 99m Sulfur Colloid; Tomography, X-Ray Computed

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

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

A patient with metastatic gastric carcinoma and malignant ascites developed sudden-onset dyspnea secondary to a new large left pleural effusion. A radionuclide lung scan performed for suspected pulmonary embolism was indeterminate. Scintigraphy performed following intraperitoneal administration of Tc-99m sulfur colloid subsequently demonstrated rapid accumulation of activity in the left pleural space, indicating the presence of a pleuroperitoneal communication. In a patient with known or suspected ascites, a new pleural effusion, and an indeterminate lung scan, peritoneal scintigraphy may identify the origin of the effusion and obviate the need for further invasive evaluation for possible pulmonary embolism.

Topics: Aged; Diagnosis, Differential; Fistula; Humans; Male; Peritoneal Diseases; Pleural Diseases; Pleural Effusion; Pulmonary Embolism; Radionuclide Imaging; Stomach Neoplasms; Technetium Tc 99m Sulfur Colloid

A 55-year-old man with an 11-year history of intermittent right pleural effusions had continued fevers and a large right transudative pleural effusion. Minimal ascites was noted by ultrasound examination. A communication between the thorax and intraperitoneal cavity was established by radionuclide examination of the chest and abdomen. Tc-99m sulfur colloid was injected into the peritoneal cavity, and imaging at 1 and 4.5 hours confirmed passage from the peritoneal to the pleural cavity. Repeated attempts to sclerose the pleural cavity failed to decrease the transudative accumulations. The patient was subsequently treated with the placement of a LeVeen shunt.

Topics: Ascitic Fluid; Fistula; Humans; Male; Middle Aged; Peritoneal Diseases; Pleural Diseases; Pleural Effusion; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

Since the scintillation camera enables us to include lower thorax in the views obtained during Tc-99m colloid imaging of the liver and spleen, intrathoracic pathology may be identified as relatively cold or hot areas in the thoracic cavity. Eighteen patients who underwent Tc-99m sulfur colloid imaging during a one-year period were found to have intrathoracic pathology demonstrated either as photopenic areas or as areas of increased radioactivity. These patients' clinical data and the results of other diagnostic modalities, including autopsy, were correlated with the Tc-99m images. The intrathoracic disease processes recognized were bacteremia, two cases; pleural effusion, two cases; lung pathology, one case; and cardiomegaly, 13 cases. With the Exception of two patients with bacteremia who had substantial radiocolloid sequestration by the lung, all the other patients had hepatic dysfunction. The presence of compromised hepatic function allows the visualization of intrathoracic abnormalities: photopenia suggesting pleural fluid collection or an enlarged cardiac silhouette (either photopenia or increased radioactivity occupying a large space in the anterior view to yield cardiothoracic ratio of greater than 50%). Therefore, Tc-99m sulfur during colloid liver-spleen imaging, patients with hepatic dysfunction may incidentally demonstrate intrathoracic pathology, especially cardiomegaly.

Topics: Aged; Cardiomegaly; Humans; Liver; Lung Diseases; Male; Middle Aged; Pleural Effusion; Radionuclide Imaging; Retrospective Studies; Sepsis; Spleen; Technetium Tc 99m Sulfur Colloid

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

Two cases of right hepatic hydrothorax occurring in the absence of clinical ascites are reported. Diagnosis was confirmed by the intraperitoneal and intrapleural injection of radioisotope 99mTc-sulfur colloid that demonstrated the one-way transdiaphragmatic flow of fluid from the peritoneal to pleural cavities. In contrast, radioisotope injected into the peritoneal cavity of 5 patients with pleural effusions secondary to pulmonary or cardiac disease failed to traverse the diaphragm and localize in the pleural space. Medical therapy with salt and water restriction and diuretics resulted in both of the patients with hepatic hydrothorax developing signs of intravascular volume depletion without significant mobilization of the pleural fluid. Thoracotomy allowed identification of the diaphragmatic defects that were repaired by chemical and traumatic pleurodesis followed by postoperative peritoneal and pleural drainage. This therapy resulted in complete resolution of the pleural effusions, which have not recurred despite the subsequent development of clinical ascites in both patients.

Topics: Ascitic Fluid; Female; Hepatitis, Alcoholic; Hepatitis, Chronic; Humans; Hydrothorax; Liver Cirrhosis, Alcoholic; Middle Aged; Pleural Effusion; Radionuclide Imaging; Technetium Tc 99m Sulfur Colloid

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

A recurrent unilateral pleural effusion developed without obvious cause in two patients with cirrhosis of the liver. By the demonstration of the rapid passage of a radiolabelled colloid from abdomen to thorax, these effusions were proved to be secondary to clinically undetectable peritoneal effusions. A diaphragmatic tear, which had occurred during a previous splenectomy and which was apparent only at autopsy, was the cause of peritoneopleural communication in one patient. Previous surgery could also have been responsible for the pleural effusion in the other patient.

Topics: Child; Diaphragm; Female; Humans; Liver Cirrhosis; Liver Cirrhosis, Biliary; Middle Aged; Pleural Effusion; Postoperative Complications; Radionuclide Imaging; Recurrence; Splenectomy; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

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

Topics: Bronchial Fistula; Chromium; Chromium Compounds; Fistula; Humans; Male; Middle Aged; Phosphates; Phosphorus Radioisotopes; Pleural Diseases; Pleural Effusion; Radionuclide Imaging; Sulfur; Technetium; Technetium Tc 99m Sulfur Colloid

Topics: Adult; Humans; Liver; Male; Pleural Effusion; Pulmonary Atelectasis; Radiography, Thoracic; 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

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