Ascites can cause pleural effusions when the peritoneal fluid crosses the diaphragm through a pleuroperitoneal shunt in the setting of hepatic cirrhosis (hepatic hydrothorax) or malignant ascites. Scintigraphic imaging for pleuroperitoneal shunt requires intraperitoneal injection of 99mTc-SC or 99mTc-macroaggregated albumin followed by planar imaging of the chest and abdomen. Pleuroperitoneal shunt is confirmed by identifying radiotracer crossing the diaphragm from the peritoneal to pleural space. An atlas of pleuroperitoneal shunt imaging pitfalls is presented to facilitate optimal performance and interpretation of nuclear pleuroperitoneal shunt examinations. Examples include cases of nondiagnostic radiotracer injections, processing errors, and nontarget uptake.
From the *Department of Medical Imaging, Banner University Medical Center Tucson; and Departments of †Medical Imaging, ‡Medicine, and §Biomedical Engineering, University of Arizona College of Medicine, Tucson, AZ.
Received for publication April 15, 2016; revision accepted June 9, 2016.
Conflicts of interest and sources of funding: Dr Kuo received grants, personal fees, and nonfinancial support from GE healthcare outside the submitted work. The other authors have no conflicts of interest to declare.
Correspondence to: Matthew F. Covington, MD, University of Arizona Arizona Health Sciences Center, 1501 N Campbell Ave, PO Box 245067, Tucson, AZ 85724-5067. E-mail: email@example.com.