0:00

So this patient had a real transplant place

0:03

in the right lower quadrant had some delayed graph function

0:06

and so got an ultrasound and we can see in our grayscale image

0:09

quite abnormal appearing right level

0:12

quadrival transplant. So you can kind of see the borders of

0:15

it here and over here, but really along the interpolar

0:18

region looks very Mass, like looks very

0:21

enlarged. It looks quite heterogeneous. And so that itself

0:24

does not look like normal renal parenchyma.

0:27

We're measuring all this thing at 14 centimeters. That's

0:30

probably a little bit over measured and I think what's interesting to note here

0:33

is when you do color Imaging you can see there's color flow within this portion of

0:36

the renal Prime combat and whatever this is, there's absolutely no

0:39

color flow within it similarly on Power

0:42

Doppler, which is much more sensitive to flow. You can see that there is

0:45

a portion here that looks math like that's really devoid of

0:48

flow.

0:49

These portions here though. I do have color flow.

0:52

And when you sort of interrogate some of the vessels we

0:55

can see that the resistive Industries are quite high and

0:58

these are up to one with essentially no diastolic flow seen

1:01

within many of these vessels in the upper pole segmental

1:04

interlobar areas.

1:06

As well as the lower pole segmental interlobar areas. And

1:09

so again when we sort of evaluate this

1:13

renal transplant itself and you look at some of these images it becomes

1:16

clear that what you're actually seeing is a large

1:19

collection about at least 10 centimeters in length

1:22

by three and a half centimeters and thickness that is sub capsular

1:25

and causing Mass Effect upon. Can you look at the border of

1:28

the kidney here? That's sort of indented a little bit more medially.

1:32

And that's the portion of the kidney that has flow the hematoma doesn't

1:35

have flow. And so this turns out to be a large subcapsular hematoma,

1:38

which is causing enough Mass

1:41

Effect upon the vessels within the kidney such

1:44

that their resistive indices within the kidney itself

1:47

is high and there's increased vascular resistance internally. So

1:50

again, the differential for elevator is the disease can

1:53

be a number of things. It can be certainly ATN in the

1:56

first three days acute rejection in the first week to three weeks

1:59

and chronic rejection and about the first three months but there

2:02

are other causes that can do including large hematomas that

2:05

cause Mass Effect upon the kidney we can see how in this instance a

2:08

large enough hematoma can certainly cause enough Mass

2:11

effects that the diastolic flow decreases

2:14

and the reason to the next goes up.