Female 55 years old s/p renal transplant 11/4/2016 now with fevers, leukocytosis, and elevated creatinine. RENAL TRANSPLANT: LOCATION: Right iliac fossa.PERITRANSPLANT TISSUES: Medial to the transplant kidney and lateral to the urinary bladder is a 12.4 x 10.8 x 7.2 cm heterogeneous collection without color Doppler flow. A small amount of simple appearing fluid is present lateral to the transplant kidney.KIDNEY: The transplant kidney measures 12.3 centimeters in length. The parenchyma is echogenic with increased cortical medullary differentiation. There is no hydronephrosis.COLLECTING SYSTEM/URETER: No hydronephrosis.URINARY BLADDER: The bladder is decompressed.VASCULAR DOPPLER DATA: Color and spectral Doppler were performed on inflow and outflow vessels Iliac artery peak systolic velocity 119 cm/s; resistive index 0.83Peak systolic velocity at the anastomosis is 104 cm/s; resistive index 0.93Proximal right renal artery peak systolic velocity 131 cm/s; no forward flow during diastole; resistive index 0.94Mid right renal artery peak systolic velocity 114 cm/s; reversal of diastolic flow; resistive index 1.13Distal right renal artery peak systolic velocity 111 cm/s; reversal of diastolic flow; resistive index 1.09Right renal artery at the hilum peak systolic velocity 117 cm/s; reversal of diastolic flow; resistive index 1.08The arcuate arteries have peak systolic velocities between 30.6 and 99.6 cm/s and resistive indices of 1.0-1.2. Diastolic flow is reversed throughout.The renal vein and renal vein anastomosis appear patent. In retrospect, there was a nonocclusive thrombus in the renal vein on the prior CT of the abdomen and pelvis.OTHER: No significant abnormality noted
1.Echogenic renal transplant parenchyma compatible with acute rejection or ATN, see discussion below.2.Elevated resistive indices throughout the transplant kidney vessels and reversal of diastolic flow from the proximal right renal artery and more distally. The renal vein appears patent however, in retrospect, a small nonocclusive thrombus was present within the renal vein on the prior CT. The findings may be secondary to nonocclusive renal vein thrombus or mass effect from the perinephric collection.3.12.4 x 10.8 x 7.2 cm heterogeneous collection medial to the transplant kidney corresponds to the previously described hematoma, which may now be infected.