0:00

This patient had a renal transplant and

0:03

it's about seven to eight months out from

0:06

having this renal transplant and patient had

0:09

acute kidney injury and we got an ultrasound to

0:12

evaluate the potential ideology. We start off with a grayscale

0:15

images and we can see that in this instance

0:18

the cortical measure differentiation a little bit more pronounced, but that's

0:21

okay. We can sometimes see that in the setting these renal transplants because

0:24

they're placed so superficially so you can actually see some of that differentiation

0:27

as a result of that but one

0:30

thing that I wanted to show in this case is this other finding look

0:33

at this echogenic stuff within the renal collecting system

0:36

over here. Now, there are very amounts of different

0:39

echogenicities within the renal sinus and this all is going

0:42

to be fat. This is much brighter and look what's going on posterior to

0:45

it. There's a little bit of shadowing.

0:47

Now this is not the nice black clean

0:50

shadowing. We see with stone but rather.

0:53

It's almost like it's composed of low level Echoes and

0:56

it's what we call sort of dirty shadowing.

0:59

And so that appearances quite characteristic

1:02

of gas in the renal collecting system

1:05

so we can see that immediately in our gray skill images and as

1:08

we interrogate this more you can see this highly echogenic

1:11

focused with posteriority shadowing.

1:14

We're going to sort of look at the kidney as well.

1:17

Look at the vessels which

1:19

I'm going to sort of skip over in this instance because I

1:22

wanted to go to the specifics of this case again

1:25

academic Foci dirty shadowing within

1:28

the lower pole over here.

1:30

and

1:32

over here again academic shadowing echogenic Foci

1:35

a little bit of more clean

1:38

shadowing a little bit of dirty shadowing here. And so all these

1:41

findings are really compatible gas and collecting system. You can

1:44

see beautifully over here. Now when we see gas in the collecting system one

1:47

thing you certainly have to be worried about a certain infection associated with

1:51

this an emphasemide is highlight. Is that sort of infection, but it's

1:54

important to remember that a lot of these transplanted patients.

1:58

Will have fully catheters in place.

2:01

And in this instance, you can see the bladder over here with a Foley catheter

2:04

and inserting the Foley catheter you often get

2:07

gas within the bladder and some of that gas can then

2:10

reflux upwards to the renal transplant. And so

2:14

certainly when you see sort of gas in the collecting system.

2:17

You could be worried about infection. But it's

2:20

also remember to suggest that perhaps to Simply reflects reflux

2:23

from the fully catheter within the bladder. And really

2:26

the only way you're going to differentiate that is clinically. So

2:29

the patient is behaving very sick that they're infected.

2:32

They have leukocytosis, etc. Etc. Maybe then

2:35

this cast represents an infection. However, if there

2:38

are otherwise, okay from an infectious ideology, then this

2:41

is simply just going to be reflects of gas from

2:44

the fully catheter that has been inserted inside the bladder.