Subphrenic haematoma post-transplant

These can frequently be demonstrated and monitored with ultrasound. These may represent haematoma (Fig. A), seroma, loculated ascites or biloma. It is not possible to differentiate different types of collection with ultrasound alone. The appearances are taken in conjunction with the clinical features and the role of ultrasound is primarily to monitor the gradual resolution of the collection. It is important to determine if a collection is infected in a clinically ill patient. This cannot be done on the ultrasound appearances alone and guided aspiration is usually required. Haematomas frequently resolve if left untreated.

However, a large haematoma could result from an anastomotic leak requiring surgical intervention. A leaking bile duct anastomosis is potentially a serious

complication which could cause peritonitis. Drainage under ultrasound guidance is a temporary option but surgical repair is invariably necessary Recent recipients of liver transplants will oftenbhave some free intraperitoneal fluid and a right pleural effusion, which resolve spontaneously

Rejection

Rejection episodes are common in the first 2 weeks after transplantation. Graft rejection may be acute, in which case the immunosuppression is increased, or chronic following several acute episodes. Chronic rejection can only be treated by retransplantation. Rejection does not have any specific ultrasound features on either conventional imaging or Doppler, and the diagnosis is made from a liver biopsy following clinical suspicion.

Post-transplant malignancy Because of the immunosuppression, patients are at greater risk than normal for developing malignancy. Most of these manifest as post-transplant lymphoproliferative disorder (similar in appearance to non-Hodgkin’s lymphoma) which can affect the lymphatics, gastrointestinal tract or other organs, including the transplanted liver. The most commonly found ultrasound appearances include focal, hypoechoic liver lesions and  ymphadenopathy. Patients with malignant lesions pretransplant, such as HCC or cholangiocarcinoma, have a significant risk of recurrence after transplantation

FIG.A

Ultrasound images Subphrenic haematoma post-transplant

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