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Radiological diagnosis of dialysis-associated complications.

Zandieh S, Muin D, Bernt R, Krenn-List P, Mirzaei S, Haller J - Insights Imaging (2014)

Bottom Line: In daily clinical practice, the radiologist in the context of diagnosis often faces dialysis-associated complications.The complications are numerous and range from infections, catheter dysfunctions, haematomas, cardiovascular diseases, digital ischaemia, and pseudoaneurysms to shunt stenosis.In this pictorial essay, we take a close look at the imaging diagnostics of the most common complications in dialysis patients.

View Article: PubMed Central - PubMed

Affiliation: Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Vienna, EU, Austria, shahin.zandieh@chello.at.

ABSTRACT
In daily clinical practice, the radiologist in the context of diagnosis often faces dialysis-associated complications. The complications are numerous and range from infections, catheter dysfunctions, haematomas, cardiovascular diseases, digital ischaemia, and pseudoaneurysms to shunt stenosis. In this pictorial essay, we take a close look at the imaging diagnostics of the most common complications in dialysis patients. Teaching Points • The occurrence of venous stenosis in haemodialysis patients is up to 41 %. • Catheters usually have a fibrin sheath that can be rinsed but not aspirated. • The steal phenomenon occurs in 75-90 % of patients with a shunt system. • Arterial pseudoaneurysms can cause a number of complications.

No MeSH data available.


Related in: MedlinePlus

In a 51-year-old male patient with elevated inflammatory laboratory parameters, ultrasound examination shows a hypoechoic structure along the dialysis catheter in the subcutis, which corresponds to inflammatory changes (white arrow)
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Fig12: In a 51-year-old male patient with elevated inflammatory laboratory parameters, ultrasound examination shows a hypoechoic structure along the dialysis catheter in the subcutis, which corresponds to inflammatory changes (white arrow)

Mentions: In peritoneal dialysis, bacterial infections often result in peritonitis, which usually manifests in fever and abdominal pain. The standard therapy for bacterial infections is antibiotic therapy without interruption of the dialysis. However, this does not always lead to the desired success. In therapy-resistant cases, the catheter should be removed. There is a possibility that bacteria may grow in the interior of the catheter, especially when the work is done in an unhygienic manner; blood runs back into the catheter and is not rinsed out immediately. As a result, tiny clots often form on the catheter wall, providing a suitable breeding ground for bacteria. They can enter the bloodstream and cause fever during the next infusion. Occasionally, a general infection (sepsis) may arise with complications such as spondylodiscitis or endocarditis. As a rule, in such a case, the catheter is removed; however, antibiotic therapies may also be attempted. About 39 % of catheter removals are because of an infection at the exit site or a tunnel infection that does not respond to antibiotics [50]. Clinically, it is important to recognise whether a catheter infection exists at the exit site, since it has a greater risk of not responding to antibiotics and more often results in catheter removal [51, 52]. Infections at the exit site and tunnel infections are characterised by erythaema and pressure pain. Especially with PD, ultrasound is very well suited for the detection of latent infections [51, 52]. The application of ultrasound is enormously important during follow-up, because in case of persistence of fluid collection over a period of more than 2 weeks of antibiotic shielding, a catheter change is recommended. Otherwise, there is a risk of peritonitis (Figs. 13, 14, 15, and 16).Fig. 13


Radiological diagnosis of dialysis-associated complications.

Zandieh S, Muin D, Bernt R, Krenn-List P, Mirzaei S, Haller J - Insights Imaging (2014)

In a 51-year-old male patient with elevated inflammatory laboratory parameters, ultrasound examination shows a hypoechoic structure along the dialysis catheter in the subcutis, which corresponds to inflammatory changes (white arrow)
© Copyright Policy - OpenAccess
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4195842&req=5

Fig12: In a 51-year-old male patient with elevated inflammatory laboratory parameters, ultrasound examination shows a hypoechoic structure along the dialysis catheter in the subcutis, which corresponds to inflammatory changes (white arrow)
Mentions: In peritoneal dialysis, bacterial infections often result in peritonitis, which usually manifests in fever and abdominal pain. The standard therapy for bacterial infections is antibiotic therapy without interruption of the dialysis. However, this does not always lead to the desired success. In therapy-resistant cases, the catheter should be removed. There is a possibility that bacteria may grow in the interior of the catheter, especially when the work is done in an unhygienic manner; blood runs back into the catheter and is not rinsed out immediately. As a result, tiny clots often form on the catheter wall, providing a suitable breeding ground for bacteria. They can enter the bloodstream and cause fever during the next infusion. Occasionally, a general infection (sepsis) may arise with complications such as spondylodiscitis or endocarditis. As a rule, in such a case, the catheter is removed; however, antibiotic therapies may also be attempted. About 39 % of catheter removals are because of an infection at the exit site or a tunnel infection that does not respond to antibiotics [50]. Clinically, it is important to recognise whether a catheter infection exists at the exit site, since it has a greater risk of not responding to antibiotics and more often results in catheter removal [51, 52]. Infections at the exit site and tunnel infections are characterised by erythaema and pressure pain. Especially with PD, ultrasound is very well suited for the detection of latent infections [51, 52]. The application of ultrasound is enormously important during follow-up, because in case of persistence of fluid collection over a period of more than 2 weeks of antibiotic shielding, a catheter change is recommended. Otherwise, there is a risk of peritonitis (Figs. 13, 14, 15, and 16).Fig. 13

Bottom Line: In daily clinical practice, the radiologist in the context of diagnosis often faces dialysis-associated complications.The complications are numerous and range from infections, catheter dysfunctions, haematomas, cardiovascular diseases, digital ischaemia, and pseudoaneurysms to shunt stenosis.In this pictorial essay, we take a close look at the imaging diagnostics of the most common complications in dialysis patients.

View Article: PubMed Central - PubMed

Affiliation: Institute of Radiology and Nuclear Medicine, Hanusch Hospital, Teaching Hospital of Medical University of Vienna, Vienna, EU, Austria, shahin.zandieh@chello.at.

ABSTRACT
In daily clinical practice, the radiologist in the context of diagnosis often faces dialysis-associated complications. The complications are numerous and range from infections, catheter dysfunctions, haematomas, cardiovascular diseases, digital ischaemia, and pseudoaneurysms to shunt stenosis. In this pictorial essay, we take a close look at the imaging diagnostics of the most common complications in dialysis patients. Teaching Points • The occurrence of venous stenosis in haemodialysis patients is up to 41 %. • Catheters usually have a fibrin sheath that can be rinsed but not aspirated. • The steal phenomenon occurs in 75-90 % of patients with a shunt system. • Arterial pseudoaneurysms can cause a number of complications.

No MeSH data available.


Related in: MedlinePlus