0:00

So this is a patient who has renal

0:03

transplant had Rising creatinine and got an ultrasound to evaluate

0:06

the ideology of it. And the first thing we know is that this patient

0:09

has a transplant the left lower quadrant. Now remember

0:12

that most transplants are preferentially placed in the

0:15

right lower quadrant. So if we see a leftover quadrant transplant, it may

0:18

be because the patient had a prior right lower quadrant transplant that

0:21

fails which was the case in this instance. Now in this

0:24

instance with the rising creatinine, we do see a finding that his

0:27

concerning which is high turniprosis on

0:30

the grayscale images. Now, you may see some degree of normal fullness

0:33

in the renal collecting system post transplant, but this is way too

0:36

big look at the kaleces that are

0:38

Rounded assistance look at the pelvis which is quite

0:41

dilated. And so certainly you know, Hydro nephrosis

0:44

can have multiple ideologies building external compression

0:47

internal filling defects including stones or

0:50

blood clots or stricture itself, which may be

0:53

related to faulty Imaging technique. It could be

0:56

related to ischemia. We're not always going to figure out the ideology, but

0:59

certainly one of the roles for us as images is

1:02

to identify that it is present so we

1:05

can learn our providers to it. So certainly lots

1:08

of hydronephrosis moderate at the very least I would

1:11

say and when we look at the color Imaging we do

1:14

see that there's flow throughout this renal transplant, which is a good sign.

1:17

When we interrogate some of these intraprine communal

1:20

arteries you notice that the resistive indices are sort of

1:23

on the higher end. So there's great sharpsystolic upstroke

1:26

and there is flow and diastole but it is

1:29

relatively diminished. I would say resulting in

1:32

a resistive index that is on the higher end here 0.77 is

1:35

probably top normal if we look

1:38

at other

1:38

So here's 0.7 is probably more within normal

1:41

limits.

1:42

But one of the reasons that if I need to understand if hydronephrosis

1:45

is clinically significant, I look at

1:48

the resistiv indices within the intraprine combo vessels and if those are elevated

1:51

that may be a sign that this hydronephrosis is

1:54

significant and essentially compressing the renal parenthement compressing

1:57

some of the vessels resulting increased vascular resistance.

2:00

Now, there may be other costs of elevated resist indices

2:03

as we'll talk about in this course. However, hydronephrosis

2:06

is one cause and so that may be

2:09

clue to tell you that this is not just physiologic and maybe

2:12

something that is clinically significant. Now this

2:15

instance this is interrogated the nephrostomy to

2:19

placement and check until we can do that. We

2:22

actually see in the left lower quadrant massively just tend

2:25

to collecting system and a really abnormal course

2:28

of the viewer to which almost takes a

2:31

little bit of a hairpin turn over here. And when

2:34

you look at it look how narrow this portion

2:37

of the ureter approximal ureter is and so in this

2:40

instance hydrant and ferocious was due to

2:42

Picture of ideology which was never figured out but this

2:45

was balloon dilated and as stent was

2:48

placed in order to alleviate some of the distention.