0:00

So this patient has a renal transplant has acute

0:03

kidney injury and it's about two to

0:06

four weeks out from the renal transplant. So we look on the

0:09

grayscale image to transplant itself looks reasonably. Okay in the

0:12

right lower quadrant, we can certainly measure it look for

0:15

color flow within it and there's color flow throughout the renal transplant all

0:18

the different areas and

0:21

As you start to sort of look at the grayscale and color Imaging on

0:24

the transverse images. This is at the level of lower pull you

0:27

start to see that there's this relatively high blood anechoic

0:30

collection adjacent to the renal transplant.

0:33

So that's something we're going to interrogate you can sort of see it over there as

0:36

well.

0:37

Here a nice image that demonstrates this collection.

0:40

There's a parent flow within it but that's probably artifactual. Most

0:43

of it is

0:45

a vascular and a measure is about 7.7 centimeters.

0:48

You can see another measurement over

0:51

here and the transverse Dimension and I like

0:54

this image because it sort of shows you the relationship with this collection to

0:57

the transplanted kidney and the bladder and sort of

1:00

interposed between the two and so then

1:03

we can go about evaluating the kidney itself in terms of its vessels,

1:06

but I really just want to focus on this collection that we see

1:09

And in and of itself, it's sort of nonspecific. Right

1:12

just sort of collections. You can see posts transplant

1:15

can be hematomas. Those typically have fluid

1:18

hematocrit levels and are seen more often in the immediate

1:21

postoperative setting so maybe within the first couple of days or

1:24

post biopsy.

1:26

We can also see things like lymphocyles or abscesses abscesses

1:29

are typically diagnosed in the

1:32

setting of leukocytosis or any clinical suspicion for infection

1:35

lymphocylls tend to look a little bit more complex with

1:38

citations within them and then the last collection that

1:41

we can see in the setting of the original transplants are

1:44

urinomas now uranomas are uncommon.

1:47

Typically are seen within two weeks of the transplanted surgery

1:50

and they typically occur due

1:53

to a leak at the anastomosis between the ureter or

1:56

bladder. And so where you

1:59

look for these collections are again, then typically between the

2:02

transplanted kidney and the bladder so

2:05

that sort of the classical location of where you would

2:08

look for urinoma.

2:10

Symptoms tend to be non-specific. So that's not going to help you

2:13

figure out with the patient as a urinal or not. The Imaging appearance

2:16

when compared to some of the other collections such as hematomas and

2:19

lymphocyles and abscesses. They tend to look a little

2:22

bit more simpler a little bit more anechoic that in

2:25

and of itself is not always useful but that's just something that you could

2:28

remember when you're looking at these urinomas ultimately ultrasound

2:31

is really used to establish the presence

2:34

of this collection to measure it and to potentially help

2:37

guide any Imaging guided drainage of

2:40

it, which if performed in the case of a urinoma will

2:43

show creatin and potassium concentrations that

2:46

are greater than those in blood serum. So that's really how

2:49

you're gonna make that diagnosis that was done in this instance

2:52

in this indeed turned out to be a urinoma