9%20ECOGRAFIA%20ABDOMINAL%20COMO%20CUANDO%20DONDE
You also want an ePaper? Increase the reach of your titles
YUMPU automatically turns print PDFs into web optimized ePapers that Google loves.
THE RENAL TRACT 187<br />
A<br />
Figure 7.27 A lymphocoele adjacent to the upper pole<br />
of a transplant kidney. Ultrasound monitored the gradual<br />
resolution of this collection.<br />
B<br />
Figure 7.26 (A) Transplant rejection: peri-infundibular<br />
thickening (arrows) is demonstrated and the renal<br />
parenchyma looks abnormally hyperechoic with<br />
increased corticomedullary differentiation. (B) The<br />
Doppler indices are raised in this rejecting kidney, with<br />
no EDF. Loss of corticomedullary differentiation is noted<br />
in the kidney.<br />
●<br />
surgical laparoscopic marsupialization is the<br />
treatment of choice.<br />
Haematoma An immediate postoperative<br />
phenomenon which usually resolves<br />
spontaneously. If the haematoma is due to an<br />
anastomotic leak at the main artery or vein, it<br />
can compress the renal vein, causing<br />
thrombosis in rare cases. On ultrasound, the<br />
haematoma can appear hyperechoic and illdefined<br />
in the early stages. As it resolves and<br />
liquefies, the margins become more defined<br />
and the centre becomes anechoic. Hyperechoic<br />
blood clots and strands of fibrin may be seen<br />
within the haematoma.<br />
●<br />
●<br />
Urinoma This occurs as a result of an<br />
anastomotic leak in the ureter. Urinomas are<br />
uncommon, but may progress to urinary<br />
ascites. They occur early following the surgical<br />
procedure, unlike lymphocoeles.<br />
Abscess If any of the above fluid collections<br />
becomes infected, this leads to an abscess.<br />
Hyperechoic debris can be seen in the<br />
collection and this may be treated with<br />
percutaneous drainage.<br />
Vascular complications<br />
Vascular occlusion<br />
Colour and spectral Doppler are essential for the<br />
diagnosis of postoperative vascular complications.<br />
Non-perfusion may be total or lobar (Fig. 7.28).<br />
Focal areas of hypoperfusion may be due to<br />
oedema in focal infection, arteriovenous fistula or<br />
severing of an accessory artery during harvesting of<br />
the transplant or at the time of implantation. Total<br />
vascular occlusion is rare, but occurs early. Patients<br />
may be asymptomatic and non-perfusion of the<br />
transplant may be inadvertently seen on either a<br />
routine scan or isotope study. Graft nephrectomy is<br />
the most likely outcome. Conversely, the<br />
appearance of good renal perfusion throughout<br />
the kidney on colour or power Doppler does not<br />
necessarily indicate normal vascularity and severe
Change language