[Utility of SPECT-CT in the identification of fistulas in a peritoneal scintigraphy].

A 41-year-old woman was diagnosed with chronic renal disease (CRD) due to interstitial nephropathy secondary to chronic pyelonephritis, arterial hypertension and hyperuricema. She initiated treatment with peritoneal dialysis (PD) in 2007. Four years later she underwent cadaveric kidney transplant in the right iliac fossa requiring transplantectomy 48h later due to venous thrombosis of the graft. The patient reinitiated peritoneal dialysis. Eight months later she consulted for the progressive appearance of swelling in the right hemiabdomen in the previous 2 months. On examination important edema was observed in the inferior right hemiabdomen and lumbar fossa with the sensation of stiffness. On suspicion of peritoneal leakage a scintigraphic study was requested forwhich 150MBq of 99mTc-MAA (albuminmacroaggregates) were infused through the catheter in 2 liters of peritoneal dialysis solution (Physioneal 35, glucose 3.86%, Baxter). Early images were obtained at 20min in lateral and anterior posterior projections in prone and supine positions using a Siemens e.cam dual head gamma camera (Erlangen, Germany). At 4 fours and after the peritoneal lavage, leaving 100ml of residue, the image sequence was repeated including an image of the thorax to rule out supradiaphragmatic leaks (Fig. 1). A complementary abdominal SPECT-CT study (Fig. 2) was performed in a General Electric Infinia Hawkeye gamma camera (Minnesota, USA). The scintigraphic study showed 2 peritoneal leaks toward the abdominal wall located in the right iliac