Peritoneal Scintigraphy in the Detection of Pleuroperitoneal Leak in a Patient with CAPD

Pleuroperitoneal leak (PPL), defined as the movement of peritoneal dialysate into the pleural cavity through congenital or acquired defects in the diaphragm, is an uncommon but clinically significant complication of continuous ambulatory peritoneal dialysis (CAPD), often requiring discontinuation of therapy. We report an 8-year-old girl with nephronophthisis leading to end-stage renal disease (ESRD) on CAPD, who presented with recurrent right-sided pleural effusions. Despite prior pleurodesis, she developed gross hydrothorax with reduced dialysate return and respiratory distress, raising suspicion of a dialysate leak. Pleural fluid analysis revealed a transudative effusion. Peritoneal scintigraphy using Tc 99m sulfur colloid demonstrated tracer migration into the right pleural cavity, confirmed on single photon emission computed tomography/computed tomography (SPECT/CT). Peritoneal scintigraphy is a simple, safe, and non-invasive modality for diagnosing pleuroperitoneal leaks, enabling prompt and appropriate management.