0:00

So this is a patient who had a transplant place about

0:03

three days prior to this ultrasound being

0:06

obtained and Transplant was not working well

0:09

until they got an ultrasound to evaluate it and so on the

0:12

grayscale image we can see this right lower quadrinal Transit measures

0:15

about 12.6 centimeters. You can see that there

0:18

is color flow within this transplanted kidney. However, when we

0:21

sort of interrogate the arteries this way form looks very very

0:24

abnormal. Now, there's nice sharp systolic upstroke,

0:27

but look at the diastolic flow completely reversed

0:30

over here.

0:32

And soon we see that finding a reversed

0:35

diastolic flow that suggests that there

0:38

is significant vascular resistance within

0:41

the kidney which may be from a number of causes. It could

0:44

be severe acute tubular necrosis in

0:47

the appropriate time for you could be very very severe acute rejection

0:51

to me even be very severe infection of the kidney

0:54

Pile in ephritis that's causing so much edema resulting in

0:57

increased vascular resistance. However, one of

1:00

the things and this is classically associated with the reverse diastolic flows

1:03

in the renal arteries is renal vein thrombosis.

1:06

And so that's something we're going to have to think about as we interrogate

1:09

this kidney further. Now other areas that we

1:12

look within the kidney also shows the reverse diastolic flow

1:15

showing that this is not just sort of a one-off observation mean

1:18

a portion of the kidney here. There's reverse

1:21

diastolic flow here. There's reversedological so

1:24

both in the upper and lower poles is reverse istolic flow

1:27

very very abnormal waveform.

1:30

Now we look around the kidney. We are seeing collections as well.

1:33

And sometimes when you see large collections pressing upon

1:36

the kidney with Mass Effect, you could also result in Reverse

1:39

diastolic flow. But in this instance while they are a large,

1:42

they don't seem to be indenting the kidney. They don't seem to be having sort of

1:45

a subcapsular component to it rather just sort of perinecric.

1:49

And we sort of then evaluate the remainder of this kidney.

1:53

you know, even when we look at some of the

1:55

I mean real arteries. We're seeing this reverse diastolic flow.

1:58

So all that is consistent with something that's

2:01

causing massive amount of vascular resistance within the

2:04

kidney and finally, you know, we need to look at the main renal

2:07

vein.

2:08

Despite our best efforts on color Doppler Imaging and now

2:11

power doppler everything which is much more sensitive. We're just not

2:14

seeing the main renal vein. And in fact, when we look at the external iliac

2:17

vein beyond the expected preach in

2:20

the last to Moses were actually seeing from this within it,

2:23

right. There's no flow here. There's all these low level Echoes within

2:26

it and so in this instance, there was

2:29

a thrombus within the external iliac vein that extended

2:32

into the main renal vein of the transplant. That's

2:35

kidney resulting in renal vein thrombosis and

2:38

then the resultant manifestation for

2:41

verse diastolic flow within the

2:44

renal artery itself.

2:47

Now renaline thrombosis is quite uncommon. You typically

2:50

see it in about the first five days, but even

2:53

within that particularly the first two days from the post-operative period

2:57

and you're really just looking for thrombus within

3:00

the main renal Lane associated with this sort of secondary findings of

3:03

reverse diastolic flow within the intraprenchymal vessels

3:06

in the renal transplant.