PMC9812942_01
(A,B) Ultrasound of the kidney allograft with abnormal echogenicity and ill-defined hyperechoic areas with poor acoustic shadowing, raising suspicion of air in the pelvicalyceal system.
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F1
Ultrasound of the right lower quadrant allograft was suspicious of intraparenchymal gas without any hydronephrosis (Figures 1A, B).
(a) Axial and (b) coronal CT images of the abdomen demonstrating the right lower quadrant kidney transplant with air in the renal collecting system. (c) Axial and (d) coronal CT images of the abdomen demonstrating right lower quadrant kidney transplant with loss of cortico-medullary differentiation and developing a complex intraparenchymal fluid collection with adjacent soft tissue perinephric rind. There is debris throughout the collecting system.
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F2
CT scan of the abdomen showed EPN involving the transplanted kidney with possible perinephric abscesses and thickening of the urinary bladder consistent with cystitis (Figures 2a-d).
(a) Explant of kidney allograft demonstrating multiple abscesses with fibrinous exudate and thick rind material. (b) Bisected kidney allograft demonstrating diffusely pale parenchyma and multifocal areas of purulent exudate.
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F3
Based on ongoing abdominal pain and the patient's deteriorating clinical course, a transplant nephrectomy was performed 4 days after admission (Figures 3a, b).
(a) Cortical abscess with marked neutrophilic inflammation and associated tissue destruction. Zones of tissue necrosis with abscess, such as pictured here, were present extensively throughout the resection specimen (H&E, 10x). (b) Severe interstitial neutrophilic inflammation with associated abundant intratubular abscesses (H&E, 20x). (c) High power view of neutrophilic inflammation with associated cellular debris (H&E, 40x).
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F4
Pathology of the explant showed extensive cortical and medullary abscess formation with associated tissue destruction (Figures 4a-c).