0:00

This patient had a renal transplant about

0:03

a decade prior to this Imaging study had low-grade

0:06

fevers had back pain. The transplant was

0:09

not functioning too. Well, so they wanted to sort of look at it before they

0:12

proceeded with potential retransplantation. And

0:15

so we'll start off with our grayscale images

0:18

in this instance. We actually shut off by looking at the bladder. You can see a

0:21

bladder Walter is actually quite trabeculated suggesting that they're some degree

0:24

of bladder Outlet obstruction, which may be from an enlarged

0:27

prostate gland in this instance the ureters a

0:30

little bit dilated as well quite more dilated

0:33

in the mid portion. And so

0:35

We'll sort of ignore those findings for the

0:38

moment and go right to the kidney itself here.

0:42

You can see the measurement here about 12 inch change on

0:45

the grayscale image. And remember one of the things we look for the grayscale

0:48

images are masses and then we look for collections around the kidney.

0:51

And at least on this image. I'm not seeing a mass and this

0:54

image. I'm not seeing anything here. We have a color image, but right

0:57

here on this image.

0:59

Things look pretty reasonable except for this

1:02

portion over here.

1:04

Right. So there is this typo kind of roundish appearing

1:07

lesion.

1:09

Associated with the real transplant

1:12

and there is a little bit of heterogeneity because it looks like it has some hypercode components

1:15

within it as well.

1:17

Now we picked up on that. We're trying to assess that. There's

1:20

color flow. There may be a little bit of color flows is powered off

1:23

which is very very sensitive to low level flow hard to know if that's

1:26

artifactor real flow, but it's possible has a little bit of flow

1:29

within this

1:30

and you can see it again here on the gray scale image the more you

1:33

look the more you realize this is a real lesion.

1:36

Color Doppler image doesn't really show flow. But again,

1:39

this is not a sensitive to very subtle and slow flow.

1:43

Here we have another beautiful image of this hypochoic Mass

1:46

a little bit of heterogeneity within it measuring about

1:49

2.7 centimeters with no real

1:52

flow on color Doppler Imaging build. There

1:55

may be subtle flow that we're just missing over here.

1:57

And so looking at this you have

2:00

to be worried about a neoplasm and as

2:03

it turns out these real transplant patients do have an increased

2:06

risk of malignancy compared to the general population. And that's

2:09

thought to be due to their prolonged immunosuppression that

2:12

they're on now the primary renal cancers can develop

2:15

within the renal transplant itself or

2:18

actually even within the native kidneys and the Imaging appearance of

2:21

these phenol neoplasms, there's variable and this instance

2:24

you're seeing sort of a heterogeneous hypoconic mask

2:27

and has variable amount of cystic components variable amount

2:30

of calcifications.

2:32

Flow that may or may not be picked up an ultrasound but

2:35

perhaps on CT and particularly Mr. Imaging you may see

2:38

the flow Within These masses this was biopsied and

2:41

this did turn out to be a real Salt carcinoma.