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Complications of Continuous Ambulatory Peritoneal Dialysis

Findings on MR Peritoneography

Rupert W. Prokesch1, Wolfgang Schima1, Ewald Schober1, Andreas Vychytil2, Veronika Fabrizii2 and Till R. Bader1

1 Department of Radiology, University of Vienna, Waehringer Guertel 18-20, A-1090 Wien, Austria.
2 Department of Nephrology, University of Vienna, A-1090 Wien, Austria.



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  		Fig. 1A. —37-year-old man with bilateral retroperitoneal leaks. Axial fat-saturated turbo spin-echo T2-weighted MR image obtained after continuous ambulatory peritoneal dialysis shows large bilateral fluid collections (arrows) in perirenal space.

 


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  		Fig. 1B. —37-year-old man with bilateral retroperitoneal leaks. Axial T1-weighted fast low-angle shot MR image reveals residual gadodiamide-dialysate mixture in peritoneal cavity (open arrow). Note leakage of hyperintense fluid into perirenal space (solid arrows).

 


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  		Fig. 2A. —29-year-old man with recurrent right-sided pleural effusions caused by diaphragmatic leakage after continuous ambulatory peritoneal dialysis. Axial T1-weighted fast low-angle shot MR image shows hyperintense gadodiamide-spiked dialysate in peritoneal cavity (short solid arrow) and in right pleural cavity (open arrow). Note small leak in right hemidiaphragm (long solid arrow).

 


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  		Fig. 2B. —29-year-old man with recurrent right-sided pleural effusions caused by diaphragmatic leakage after continuous ambulatory peritoneal dialysis. Intraoperative view onto right hemidiaphragm confirms small mushroom-shaped defect (arrows).

 


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  		Fig. 2C. —29-year-old man with recurrent right-sided pleural effusions caused by diaphragmatic leakage after continuous ambulatory peritoneal dialysis. Intraoperative view shows that patch was sutured over defect. Arrow points to patch.

 


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  		Fig. 3A. —42-year-old woman with large leak in right hemidiaphragm. Axial T1-weighted fast low-angle shot MR image obtained before continuous ambulatory peritoneal dialysis shows large amount of peritoneal fluid (thick solid arrow) and opacified right-sided pleural effusion (open arrow). Note large discontinuity of right hemidiaphragm (small solid arrow).

 


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  		Fig. 3B. —42-year-old woman with large leak in right hemidiaphragm. Coronal fat-saturated T1-weighted fast low-angle shot MR image shows buckling of hemidiaphragm suggestive of discontinuity (arrow).

 


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  		Fig. 4. —Drawing shows course of peritoneal dialysis catheter in abdominal wall. Note possible directions of fluid leaks (arrows). (Modified from and reprinted with permission of [12])

 


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  		Fig. 5. —46-year-old woman with abdominal wall leak after kidney transplantation failure. Axial T1-weighted fast low-angle shot MR image shows left-sided kidney transplant. Note large ipsilateral fluid collection (arrow).

 


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  		Fig. 6. —38-year-old man with inguinal hernia. Axial T1-weighted fast low-angle shot MR image reveals inguinal hernia filled with gadolinium-spiked fluid (arrow).

 

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