Computed tomography for the management of exit-site and tunnel infections in peritoneal dialysis patients .
OBJECTIVE
To evaluate the effectiveness of computed tomography (CT) for detection of exit-site and tunnel infections with a Tenckhoff catheter.


METHODS
The study enrolled patients with exit-site or tunnel infections who underwent ultrasonography (US), CT scans, and subsequent catheter removal or partial catheter reimplantation from 2010 to 2014. Control cases on peritoneal dialysis who underwent abdominal CT scans for other reasons were randomly selected. Attenuation of the soft tissue around the Tenckhoff catheter was measured in Hounsfield units (HU).


RESULTS
9 infected cases and 15 control cases were identified. CT showed increased attenuation around the catheter in all cases, while ultrasonography detected a hypoechoic area only in one case with abscess formation. Maximal attenuation of the inflamed soft tissue was high (median, 36 HU) compared with normal fatty tissue (median, -75 HU). In all cases, one or two sites with increased fat density were observed focally along the catheter, and these areas did not always extend directly from the exit site.


CONCLUSIONS
In this retrospective study comprising a small number of cases, increased attenuation of fatty tissue around the Tenckhoff catheter correlated with exit-site or tunnel infections. CT might be an auxiliary tool for diagnosis, although CT costs much more than US and is not always available in general practice. Further prospective studies are needed. .
Keina
K
Nozaki
Yuka
Y
Kamijo
Mineo
M
Nakatsuka
Takeshi
T
Azuma
Tohru
T
Nakagawa
Hideyo
H
Miyazaki
Tetsuya
T
Fujimura
Hiroshi
H
Fukuhara
Haruki
H
Kume
Yoshitaka
Y
Ishibashi
Yukio
Y
Homma
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D055499:Catheter-Related Infections / Q000000981:diagnostic imaging*; D002408:Catheters, Indwelling / Q000009:adverse effects*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography