Case Author(s): Charles Pringle / F. Dehdashti , 7/7/95 . Rating: #D2, #Q4
Diagnosis: Renal transplant infarction
Brief history:
Status post renal transplant with recent worsening of
function.
Images:
Sequential 1 minute anterior images.
View main image(rs) in a separate image viewer
View second image(rs).
Flow images.
View third image(us).
left lower quadrant
View fourth image(ct).
Full history/Diagnosis is available below
Diagnosis: Renal transplant infarction
Full history:
Patient is status post renal
transplant in March 1995, now with declining renal
function and left flank pain.
Findings:
The scintigraphic images reveal
no significant perfusion uptake or excretion of
tracer
by the transplant kidney, with increased flow in a
rim surrounding the expected site of the
transplanted
kidney. This is consistent with a nonfunctioning
renal transplant graft. Possible etiologies include
graft
rejection or vascular occlusion.
Discussion:
Ultrasound of 7-3-95 reveals a
large perinephric collection with mottled
hyperechoic
foci. Posterior to this area there is another
echogenic mass with peripheral dirty shadowing.
This is
most consistent with an infected necrotic renal
allograft with adjacent hematoma or abscess. CT of
7-5-
95 confirms these findings with necrosis of the renal
allograft with a large amount of gas present within
this and a large peritransplant fluid collection just
anterior to the transplant kidney, which probably
represents an abscess.
Followup:
The patient's abscess
subsequently was drained and a large amount of pus
was
removed.
Major teaching point(s):
A large fluid collection
located anterior to the kidney can attenuate the
photons
and the kidney appears nonfunctioning/poorly
functioning. Therefore, a lateral view may be
needed to
separate the fluid collection from the kidney.
ACR Codes and Keywords:
References and General Discussion of Renal Scintigraphy (Anatomic field:Genitourinary System, Category:Effect of Trauma)
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Case number: rs007
Copyright by Wash U MO
