Ultrasound images Renal transplant dilatation

A mild degree of PCS dilatation is normal postoperatively, due to oedema at the site of the vesicoureteric anastomosis. This phenomenon is usually transient, and serial scans in conjunction with biochemistry (urea, creatinine) is normally all that is required. More severe dilatation may be indicative of obstruction, especially if the individual calyces are also dilated. A trend of increasing dilatation is a poor prognostic indicator. A ratio between the area of the PCS and the renal outline in two planes, the dilatation index, has been found to predict obstruction and differentiate obstructive from non-obstructive dilatation (Fig.ultrasound images below).
The ultrasound images degree of dilatation of the PCS correlates well with the severity of obstruction. Obstruction of the transplant kidney may be due to an ischaemic related stricture at the vesicoureteric anastomosis, or may be the result of a blood clot or infected debris in the ureter. Haematoma or debris within the PCS may appear echogenic but requires to be differentiated from fungal balls. Percutaneous nephrostomy is the method of choice to relieve obstruction.
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LS and (B) TS of a dilated transplant kidney, showing the measurements used to calculate the ratio
between the dilated PCS and the kidney. This kidney was dilated but not obstructed
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