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Scintigraphic assessment of pericardio-peritoneal window patency. Relevance to peritoneal dialysis
U A Joseph1, S G Jhingran, J J Olivero
1Nuclear Medicine Section, Baylor College of Medicine, Houston, Texas, USA.
Insights
A pericardio-peritoneal window managed lupus-related pericardial effusion. This procedure allowed for peritoneal dialysis but required careful management to prevent infectious pericarditis.
Area of Science:
- Nephrology
- Cardiology
- Rheumatology
Background:
- Recurrent pericardial effusion in systemic lupus erythematosus (SLE) can be refractory to medical management.
- Pericardio-peritoneal shunting offers an alternative surgical approach for refractory cases.
- End-stage renal disease (ESRD) necessitates renal replacement therapy, such as peritoneal dialysis.
Observation:
- A patient with SLE developed recurrent pericardial effusion requiring a pericardio-peritoneal window.
- The patient subsequently progressed to ESRD and initiated peritoneal dialysis via a Tenckhoff catheter.
- The patency of the pericardio-peritoneal window was confirmed using intraperitoneal injection of Tc-99m SC.
Findings:
- The pericardio-peritoneal window remained patent, allowing for successful integration with peritoneal dialysis.
- Confirmation of window patency was achieved through radioisotope scintigraphy.
- A potential complication identified was the risk of infectious pericarditis secondary to peritoneal dialysis-induced peritonitis.
Implications:
- This case highlights the successful use of a pericardio-peritoneal window in managing complex SLE complications.
- It underscores the importance of careful patient counseling regarding the risks of infectious pericarditis when combining these procedures.
- This approach may be considered in select patients with refractory pericardial effusion and concurrent renal disease.
Abstract:
To alleviate recurrent pericardial effusion secondary to systemic lupus erythematosus, pericardio-peritoneal window was performed. Subsequently, end stage renal disease developed and the patient required peritoneal dialysis. Patency of the pericardio-peritoneal window was demonstrated by intraperitoneal injection of Tc-99m SC through a Tenckhoff catheter, which prompted special counsel to the patient in order to prevent infectious pericarditis potentially complicating peritoneal dialysis induced-peritonitis.