Diagnostic ultrasound ( PDFDrive )

666 PART II Abdominal and Pelvic Sonography
A
B
C
D
FIG. 18.50 Parapelvic Cysts Versus Pelvocaliectasis in Two Patients. Patient 1: Parapelvic cysts. (A) Transverse and (B) sagittal sonograms
show multiple parapelvic cysts mimicking pelvocaliectasis. Patient 2: Grade 3 pelvocaliectasis mimicking parapelvic cysts. (C) Sagittal sonogram
shows multiple anechoic structures in the central aspect of the kidney, initially interpreted as multiple parapelvic cysts. (D) Contrast-enhanced
magnetic resonance image shows contrast illing grossly dilated calyces (*). A single parapelvic cyst (arrow) is present.
incidentally and are asymptomatic, lymphoceles are the most
common luid collection to result in ureteric obstruction.
Lymphoceles can become infected or can obstruct venous drainage,
resulting in edema of the lower limb, scrotum, or labia. 45
Symptomatic collections are drained (surgically or percutaneously)
or undergo marsupialization. On sonography, lymphoceles are
well-deined collections that are anechoic or that may contain
ine internal strands (Figs. 18.58 and 18.59).
PANCREAS TRANSPLANTATION
Pancreatic transplantation is performed in select patients who
have major complications related to type 1 diabetes. Pancreas
transplant represents the only form of self-regulating endocrine
replacement therapy, with more than 80% of recipients becoming
free of exogenous insulin requirements within 1 year of
surgery. Since 1988 in the United States, more than 15,000
kidney-pancreas transplants and 6000 pancreas transplants
have been performed, with 1-year patient survival greater
than 90%. 3,74
Pancreatic transplantation aims to restore an adequate
functioning beta cell mass and therefore to regain physiologic
normoglycemic function, typically in the setting of insulin
dependent diabetes. Recipients are typically type 1 diabetics in
end-stage renal failure with other sequelae of long-term diabetes
including neuropathy and atherosclerotic disease. Improvement
in glycemic control diminishes the risk of long-term complications
in diabetic patients. 75 In particular, simultaneous pancreas