0:00

This patient has a real transplant has Rising creatinine

0:03

into an ultrasound is obtained to evaluate potential ideologies

0:06

start off with their grayscale image and

0:09

we can see a transfer in the right lower quadrant and immediately on

0:12

this image. If you can find that there are sort of a symmetry in

0:15

a sense to the transplant appearance, whereas, you

0:18

know, this area this portion of it over here

0:21

looks a lot bigger with a focal Mass like a region

0:24

over here within the parenchyma compared to this region, which

0:27

looks relatively normal.

0:29

And so we certainly measuring the transplant over there 13 centimeters

0:32

and we start to interrogate that sort of lateral portion

0:35

of theorial transplant. And these

0:38

calipers are delineating quite a

0:41

you know, large mass about five and a half six centimeter mask

0:44

which is predominantly hypochoic. It's quite heterogeneous. And

0:47

there is a little bit of flow in it

0:50

on color Doppler Imaging and so this is highly concerning

0:53

for a neoplasm. It's certainly a solid Mass with

0:56

flow within it. This was biops in this turned out to be most

0:59

transplant lymphoproliferative disorder.

1:02

And so I wanted to take this case as a

1:05

means to talk a little bit about ptld which

1:08

is really a group of disorders resulting in lymphoid proliferation

1:11

that can result in lymphoid hyperplasia

1:14

from a histological perspective to

1:17

Frank, you know lymphoma and it

1:20

can occur in about 2.5% of transplanted patients

1:23

Radiology is multi-factorial, but

1:27

generally it occurs in

1:29

Adding of infection with Epstein-Barr virus,

1:32

which is facilitated in the setting of somebody who's immunosuppressed. Most

1:36

often patients will present within a

1:39

year of transplantation, but they can occur at a

1:42

median time of five years, which has been reported.

1:45

The appearance of it is nonspecific. It could be a solitary mass

1:48

in the renal transplant multiple masses. It can

1:51

have a diffuse sort of infiltrative. Look where involves the

1:54

whole transplant of kidney resulting in enlargement of the

1:57

kidney itself.

1:58

Sometimes can also have soft tissue

2:01

and sort of higher region of the kidney over here.

2:04

And so that's another alternative appearance. Now, you're

2:07

not going to be able to necessarily make this diagnosis prospectively

2:10

just based on this Mass. This Mass based on

2:13

Imaging may represent a renal tall neoplasm like renal

2:16

cell carcinoma, but it's important to remember that whenever you

2:19

see a transplanted patient in this instance a real

2:22

transplant and you see a solid Mass within the

2:25

transplant around the transplant potentially

2:28

as well in other locations within the body and that mass

2:31

is new you want to think about the possibility of

2:34

ptld or post transplant liver proliferative. Disorder.

2:37

You're going to make a definitive diagnosis via needle

2:40

biopsy.