A 68-year-old female treated by peritoneal dialysis (PD) for 4 years was hospitalized for cough and dyspnea without chest pain. Chest X-ray revealed massive right pleural effusion. High glucose content in pleural fluid in comparison with blood glucose level was suggestive of transdiaphragmatic leakage. To establish the communication between the peritoneal and pleural cavity, peritoneal scintigraphy was performed. Different 99mTc-labeled colloids have been used for peritoneal scintigraphy in the past years, such as sulfur colloid, macroaggregated albumin, and diethylenetriamine pentaacetic acid (DTPA), each with some important limitations. On the basis of the characteristics of icodextrin, an osmotic colloid agent routinely used in PD, such as its persistence in the peritoneal space, 99mTc-icodextrin scintigraphy was performed to confirm the diagnosis of peritoneopleural leakage (Fig. 1a, b). Therefore, 99mTc-icodextrin scintigraphy may represent a new, simple, noninvasive, cost-effective, well-tolerated, and safe radionuclide imaging method to clearly detect some causes of peritoneal dialysis failure.

Fig. 1
figure 1

99mTc-Icodextrin dynamic peritoneal scintigraphy. a Spot view of thoracic area in supine position. Note the area of thoracic leakage (arrow). b Spot view of thoracic area in standing position. Note the apparent up-dislocation and the reduction of the area of leakage (arrow), secondary to the down movement of dialysate in the peritoneum, due to gravity forces

Full size image