0:00

This is a patient with a history of renal transplant in the clinical

0:03

concern of Sir graft obstruction. And so we got a ultrasound and

0:06

on the grayscale. Let me just everything looks quite abnormal. We

0:09

can see a portion of the kidney here. But surrounding it

0:12

we can see this rather large heterogeneous collection that causing

0:15

some degree of deformity.

0:17

As we look at it in different images we can maybe better

0:20

appreciate a deformed for a renal transplant

0:23

here surrounded by this large large collection and very heterogeneous

0:26

appearing collection. There is some flow

0:29

within the renal transplant but none within this collection itself.

0:33

And as we interrogate some of the vessels we can see at least at the

0:36

level of the main order the Highland there is reverse diastolic

0:39

flow. So that finding is

0:42

worrisome. You can see it very beautifully in this instance over here.

0:45

In other portions, there may be some reverse

0:48

diastolic flow here as well. And so really an

0:51

abnormal finding we can see some in this location as well.

0:54

And so remember when we see reverse diastole that's telling

0:57

us that there is some sort of increased vascular

1:00

resistance within the kidney itself. It's

1:03

a classic finding with renal vein thrombosis. And

1:06

so the first thing you want to do look at the renal veins in this instance

1:09

the real veins where patent the other thing that can do it or severe

1:12

acute tubular necrosis severe rejection severe pilot

1:15

nephritis.

1:16

But one of the other things that can do is if you have a large collection

1:19

that is compressing the kidney itself. We saw

1:22

one case already of a subcaps or hematoma compressing

1:25

the kidney resulting in essentially no diastolic flow,

1:28

but it's also important to remember that if it's large enough

1:31

it may also cause reverse diastolic flow in

1:34

this instance. We can see the CT scan associated

1:37

with this patient showing the right lower quadrant wheel

1:40

transplant here in a very very large hematoma causing

1:43

Mass Effect upon it resulting in

1:46

the findings that we were seeing in the main renal artery

1:49

on the ultrasound.