THORACIC COMPLICATIONS IN UREMIC PATIENTS AND IN PATIENTS UNDERGOING DIALYTIC TREATMENT - STATE-OF-THE-ART

No organ in the chest is spared the negative effects of uremia. The di alytic treatment itself is often associated with a large array of thor acic complications. We review the main thoracic manifestations of the terminal uremia from the radiological point of view, such as: uremic p leuritis and pericarditis, uremic pneumonia, renal osteodystropby, inf ections, and metastaticpulmonary calcifications. Respiratory function derangement and the problems related to peritoneal dialysis and hemodi alysis are discussed in some detail, along with the diagnostic role of plain films, US, nuclear medicine, and CT. The main focus of this rev iew is on the hydration problems and pulmonary edema; often related to a large number of pathogenetic factors. Based on our experience, we t hink that the chest X-ray is not able to accurately discriminate betwe en cardiogenic edema and fluid overload edema (so-called renal pulmona ry edema). The radiological findings of the thoracic complications in uremic patients are multiple and complex but, in most cases, the imagi ng techniques may offer an accurate and noninvasive diagnostic approac h, with a high benefit-cost ratio.