0:00

This patient have a renal transplant that

0:03

was placed and had leukocytosis. And

0:06

so they wanted to evaluate the renal transplant for a potential ideology first thing

0:09

you notice placed on the left lower quadrant.

0:12

In this instance, it may have been because this was a

0:15

second renal transplant for this patient or perhaps that patient could

0:18

not get a transplant the right lower quadrant due to Anatomy reasons

0:21

for regardless. This is the transplant over here. We can see it on the

0:24

gray scale images. We measure it we look for any masses

0:27

within it look for any collections surrounding it. We see this a little

0:30

bit of fullness in the collecting systems that amount is acceptable.

0:34

And we can see that degree of fullness. Sometimes we see that there

0:37

is color flow within the renal transplant but one of the things I wanted

0:40

to draw your attention to and this is a subtle but real finding look

0:43

at the pelvis and portions of

0:46

the renal pelvis over here. Actually, you can see how thickened

0:49

it is, right? There's a little bit of anechoic content

0:53

inside of it, which is going to be here and but

0:56

the walls that are actually a little bit thickened.

1:00

and

1:01

If we look closely inside portion of the collecting system and

1:04

pelvis over here again a little bit of thickening of that area

1:07

over here again over here a little bit of thickening. It's quite subtle

1:10

and it's extending into the collecting system over here. And

1:13

so in the context of somebody who has

1:16

leukocytosis that degree of thickening would be concerning for

1:19

infection. One of the possibilities is pylitis.

1:24

Which is in fact what this patient turned out to have one of

1:27

the things you also look for is potential gas in

1:30

the collecting systems, which may represent emphysemidis pilitus,

1:33

but we do need to remember that gas the

1:36

collecting systems may also be seen from reflection of

1:39

the bladder if you place a Foley catheter and so the clinical context

1:42

becomes very important somebody as in this instance

1:45

you has leukocytosis who has thickening of the urithelial lining.

1:48

We're more worried about infection and if

1:51

we see gas would be more worried about an emphyseminist infection

1:54

sometimes with pylitis. You may see pionepherosis

1:57

where you have infectious debris filling the

2:00

collecting system resulting in distention the collecting system. We don't

2:03

quite see that at this instance. That's another Finding to

2:06

look for in cases of highlighters and

2:09

infectious conditions of the renal transplant.