0:00

This is a patient who is around post-op one

0:03

post-op day two from a pediatric on

0:06

block transplant 2 has diminished graph

0:09

function. And so we're asked to evaluate it on ultrasound start off

0:12

with a bladder image. You can see the fully catheter within it.

0:15

You can see a one of the two renal transplants here

0:18

and grayscale image.

0:20

This one is the one deemed more lateral on the

0:23

grayscale image looks relatively. Okay, but look what happens on the

0:26

color image?

0:27

You know flow at all.

0:30

Within this transplanted kidney. So that's quite worrisome. We

0:33

also use techniques to optimize any possibility

0:36

of slow flow or low flow within the kidney and we're

0:39

really not seeing in this instance. This really should

0:42

light up where it's not lighting up at all.

0:45

Again, looking at this kidney and other low

0:48

flow techniques no flow within this kidney.

0:50

We're now looking at some of the anastomoses. We

0:53

see a vessel over here, which is the external iliac vein.

0:56

We see the external iliac artery adjacent to and this

0:59

is the donor aorta for the Pediatric on block. That's an ass to most

1:02

to it. There's a little bit of flow within it but beyond it absolutely

1:05

no flow over here. So that is quite worrisome.

1:09

And we try interrogating it as well with color

1:12

Doppler Imaging. We're not seeing any flow within the renal transplant.

1:16

We see a little bit of flow within this renal aorta over here, but essentially

1:19

very high resistive flow suggesting that

1:22

there's lots of vascular resistance more distally.

1:26

Adjacent to that aorta. We actually see the IVC over

1:29

here, which I'll get has no flow within it the IVC

1:32

of the Pediatric on block renal transplants. So that's completely thrombosed as

1:35

well. And so this was sort of a very traumatic

1:38

case of

1:40

Renal artery thrombosis and renal anthrombosis

1:43

in the immediate postoperative setting and we

1:46

certainly looked at the lateral kidney here. We look at the medial kidney shows the same

1:49

findings with absolutely no flow scene within it this happens very

1:52

very uncommonly when it does happen and we'll see in a

1:55

very early post-operative period and this why

1:58

you do those transplants and immediate postoperative setting

2:01

to look for flow to look for these rare complications, which unfortunately

2:04

in this instance we were able to find