Ultrasound images Fluid collections associated with transplantation of kidneys

Up to 50% of renal transplants will demonstrate perirenal fluid. The size of the collection should
be monitored with ultrasound, as significant growth may require intervention. While it is not possible to classify the collection on the ultrasound appearances alone, the clinical picture, including the time interval following transplantation, can often be helpful.
● Lymphocoele The commonest perirenal fluid collection, lymphocoeles usually occur several weeks or months after the transplant. They may resolve spontaneously but occasionally require percutaneous drainage if large. They may compress the kidney, causing an increase in vascular resistance on spectral Doppler (Fig.ultrasound images of  ). The collection is anechoic but may contain loculations or septa. If treated, thensurgical laparoscopic marsupialization is the treatment of choice.
image
ultrasound images of A lymphocoele adjacent to the upper pole of a transplant kidney. Ultrasound monitored the gradual resolution of this collection.

● Haematoma An immediate postoperative phenomenon which usually resolves spontaneously. If the haematoma is due to an anastomotic leak at the main artery or vein, it can compress the renal vein, causing
thrombosis in rare cases. On ultrasound, the haematoma can appear hyperechoic and illdefined
in the early stages. As it resolves and liquefies, the margins become more defined and the centre becomes anechoic. Hyperechoic blood clots and strands of fibrin may be seen within the haematoma.
● Urinoma This occurs as a result of an anastomotic leak in the ureter. Urinomas are uncommon, but may progress to urinary ascites. They occur early following the surgical procedure, unlike lymphocoeles.
● Abscess If any of the above fluid collections becomes infected, this leads to an abscess.
Hyperechoic debris can be seen in the collection and this may be treated with percutaneous drainage.
Previous Post
Next Post

0 komentar: