Diagnostic ultrasound ( PDFDrive )

CHAPTER 18 Organ Transplantation 645
A
B
FIG. 18.23 Right Adrenal Hemorrhage. (A) Sagittal sonogram and (B) CT show a small right adrenal mass (arrows).
A
B
FIG. 18.24 Intrahepatic Fluid Collection. (A) Transverse and (B) sagittal sonograms show anechoic luid surrounding echogenic falciform
ligament (arrowheads).
Most oten, the kidney is aligned with its long axis parallel to
the surgical incision, with the hilum oriented inferiorly and
posteriorly. Occasionally, in obese patients, the long axis may
lie in an anterior-to-posterior plane. 48
Longitudinal and transverse measurements of the transplant
should be obtained with the kidney imaged through the hilum.
Although there are no normative data for comparison, these
measurements serve as a useful baseline for future reference to
assess for interval changes in volume of the allograt. he
transplant kidney may hypertrophy by up to 15% within the irst
2 weeks ater surgery, and eventually may increase in volume
by 40%, with the inal size attained at about 6 months. 49-51
he transplanted kidney appears morphologically similar to
the native kidney, with many of the subtle diferences attributed
to the improved resolution from proximity of the allograt to
the skin surface (Fig. 18.29, Video 18.1 and Video 18.2). he
normal renal cortex is well deined, hypoechoic, and easily
diferentiated from the highly relective, central echogenic renal
sinus fat. Apart from this improved corticomedullary diferentiation,
the renal pyramids of the allograt are more easily visualized
than in the native kidney, appearing as wedge-shaped structures
that are hypoechoic to the surrounding parenchyma. 44
he collecting system should be assessed for the presence of
hydronephrosis. If a stent is present, its proximal and distal