0:00

This patient had a renal transplant and fresh out

0:03

of the or we were asked to evaluate to make

0:06

sure that everything was looking good. And so this trans was

0:09

placed in the right lower quadrant. You can see it over here on grayscale Imaging

0:12

looks reasonably good. We don't see any big masses. We

0:15

don't see on this image at least any big collections. We can measure the transmission

0:18

we've done here and one of the important things

0:21

to do is after you get those initial gray scale images, you gotta get

0:24

color images and you really want to make sure there's flow throughout the

0:27

transplanted, kidney.

0:29

But what are we seeing over here?

0:31

Good amount of flow everywhere. There is a portion right

0:34

over here it almost look wet shaped if you want to sort of draw it

0:37

out that doesn't have flow within it.

0:39

And so that is unusual. You can

0:42

certainly look at it again on different color image over

0:45

here to see if anything changes certainly no flow again

0:48

in that area.

0:49

We're measuring some of the intraprenchymal vessels

0:52

over here coming back to that region again no

0:55

flow. And so we try different techniques

0:58

that are more sensitive to subtle areas of flow in here.

1:01

You can see all the blue area has flow this area here, which

1:04

is dark has no flow despite all

1:07

the techniques that we use and so that's sort of consistent across whatever

1:10

techniques that we try to see

1:13

if they're slow in this region. And so when you start to see that God worry

1:16

about it or you know in fart that's important

1:19

to remember that renaline Park can occur really at any time

1:22

after the patient has their transplant place and it may

1:25

be second mental as sort of seen in this instance.

1:28

Or could be quite Global as well. Not the whole kidney in

1:31

parks. There are a number of ideologies often. It

1:34

could be due to vascular thrombosis particularly. If

1:37

there's a very small accessory artery that becomes thrombosed.

1:41

emboli infections

1:44

You know if during the surgery they ligate it's a small renal

1:47

arteries on purpose or inadvertently. I would say that

1:50

maybe that could also cause a small infarct patient may present with

1:53

some pain at the site of the infarctic due to

1:56

irritation of the adjacent fascia. And this is

1:59

something you're really going to pick up when you do those color images

2:02

when you see a consistent to reach and just does not

2:05

fill with color flow. And so that would be compatible with

2:08

an infarct.