0:00

This is a patient who had acute kidney injury and is post

0:03

biopsy. They wanted to evaluate for any complications

0:06

related to the biopsy can see transplant the

0:09

right lower quadrant. Grayscale image looks pretty okay.

0:13

measures about 11 centimeters

0:15

and we see a color image and color flow seems pretty

0:18

reasonable throughout the kidneys. We sort of go into the

0:21

lower pole. We can see that there's a lot of abnormal flow

0:24

in this region relatively High

0:27

Velocity flow in this region compared to other areas. It almost

0:30

looks like there is flow that sort of bleeding out of the

0:33

vessels into the parenchymal soft tissues the so called soft tissue Brewery

0:36

that we can see into that itself is very very abnormal. We sort

0:39

of look at that more carefully and you can see that really just

0:42

sticks out as an abnormal finding or looks

0:45

certainly different from the rest of it. And so

0:48

we'll sort of interrogate that region in a little bit as we look at

0:51

the veins and the upper pull first followed by some of the arteries

0:54

we come back to that area and you can see that you know,

0:57

there are some vessels here or an artery in a vein here and as

1:00

well as this very abnormal region of flow.

1:03

And when we interrogate that region itself, you

1:06

can see there's relatively High Velocity flow at 134

1:09

centimeters per second and low resistive

1:12

index about 0.45. And so

1:15

this Imaging appearance is certainly in

1:18

the context of somebody's had a biopsy is quite characteristic for

1:21

an arterial venous fistula.

1:25

Now architis can occur quite often after renal

1:28

transplants most are insignificant. Clinically.

1:31

They're asymptomatic and quite small

1:34

and was all spontaneously if they end up

1:37

being symptomatic resulting in hematuria, they end up getting larger.

1:40

Then you may have to consider doing treatment on

1:43

Imaging classically Arturo venous fistulas

1:46

the area of the fish shell you'll see High Velocity

1:49

flow and color Alias. You can see over here. Sometimes you'll

1:52

see color signal outside of the

1:55

vessel or the fistula itself because of the soft

1:58

tissue vibrations me adjacent tissues. If you're

2:01

able to find the arterial vessel that feeds this visual of

2:04

that will have high velocity flow relatively low

2:07

resistance waveforms the vein that drains the

2:10

fistula will have arterialized flow with pulsatile flow within

2:13

it.

2:14

In the setting of an avf in the kidney, sometimes those discrete vessels

2:17

are very difficult to pick up and what you're really looking

2:20

for is color aliasing soft tissue Brewery

2:23

High Velocity low resistant flow in that area.

2:26

Especially in the context somebody had a biopsy that would be

2:29

characteristic of a our true venous vein

2:32

fistula.