Diagnostic ultrasound ( PDFDrive )

644 PART II Abdominal and Pelvic Sonography
A B C
D
E
F
G
H
I
FIG. 18.22 Extrahepatic Fluid Collection. (A)-(D) Hematoma at surgical margin of a right lobe in living related transplant. (A) Transverse
sonogram shows acute hematoma that appears echogenic, heterogeneous, and solid. (B) and (C) Hematoma liqueies after 3 weeks, with internal
strands and a luid-debris level. (D) After 2 months, further liquefaction of the hematoma appears as a smaller, anechoic collection. Arrows mark
boundary of hematoma with liver. (E) Sagittal sonogram shows hemoperitoneum around spleen (S), with luid-luid level and internal strands.
(F) and (G) Anastomotic leak from roux-en-Y. Transverse sonogram and correlative CT show large luid collection in the left lower quadrant.
(H) and (I) Biloma secondary to anastomotic leak. Sagittal sonogram and transverse sonogram show complex subphrenic echogenic collection
(arrows).
transplanted en bloc in an attempt to provide a functional renal
mass analogous to the renal mass of a single cadaveric kidney
transplanted from an adult. At harvesting, both kidneys are
removed en bloc with preservation of the ureters and main renal
arteries and veins, as well as segments of the suprarenal and
infrarenal abdominal aorta and IVC. he donor aorta and IVC
are oversewn just cephalad to the origin of the renal arteries and
veins, and the caudal ends anastomosed end to side to the recipient’s
external iliac artery and vein. he donor ureters are implanted
into the urinary bladder through individual or common
ureteroneocystostomies. 47 his surgery is more common in the
pediatric population than in adults (see Fig. 18.28).
Normal Renal Transplant Ultrasound
Gray-Scale Assessment
Sonography of the renal transplant is usually easily performed
because of the supericial location of the kidney in either the
right or the let lower quadrant. Because the allograt is held in
place by its pedicle, a variety of orientations may be encountered.