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This patient had a renal transplant about two three

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months ago, and I presented with pain. So the providers

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asked for an ultrasound.

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And so this is what we see. We have an ultrasound of

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this transplant place in the right lower quadrant again, starting off with a gray

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scale image. The first thing that you notice is that

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collecting system is quite dilated. Now again,

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while you may have some degree of facilitation that

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may be deemed physiologic with these renal transplants

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for a variety of reasons. This much is just way too

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big and you can see it on multiple gray scale images on the

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Cali cease to rounded pelvis is quite

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dilated. And so this is very abnormal and a number

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of potential causes for hydrant of roses and we can sort

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of look at this ultrasound to figure that out.

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After the grayscale image it's important to look at the color images to make

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sure that there is appropriate flow in the renal transplant in

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this instance. Some of the resistive indices are within normal

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limits slightly high you round this up to 0.8. But

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0.76 is appropriate.

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As we evaluate more the vessels there is diastolic flow within

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the renal transplant some of them again a little

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bit on the higher end. And so that may be a clue that this hydrogen and

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Frozen is causing some degree of compression of the renal parenchyma.

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And so sort of evaluate our real

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parenchymal vessels as we do with all our transplants. We're

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going to evaluate the main renal artery the main renal vein

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and I'm going to skip over some of these images because I

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really want to show is the potential ideology of this. We

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see the bladder over here. It's a little bit under distended but as

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we sort of look around the bladder and look at the anastomosis from

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the ureter to the bladder we start to see

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this echogenic Focus right at the distal ureter.

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And here you can see beautifully the ureter coming

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in ureter coming in on both walls here this echogenic

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focus with shadowing and here you

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have the bladder and so in this instance, we were

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fortunate to figure out based on the ultrasound that

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there was a stone almost at the junction of the

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transplant ureter and bladder resulting

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in quite a big degree of hydrogenfrosis here.

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We can see some twinkle artifact on color associated with

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that stone.

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Obstruction for menial calculi in the setting of renal transplants

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only occurs in about one to two percent of patients. It's

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not a common thing. It tends to be a relatively late

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complication to you're looking at at least a month out. We don't

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transplant. This patient's about two to three months out and so

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would fit in that time frame. And so this person

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would then have to have this obstruction relieved in order

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to salvage function of the renal transplant.