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IMAGING FOR RESIDENTS – ANSWER |
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| Ahead of print
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| Renal transplant: When the ultrasound does the diagnosis |
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Carolina Cairrão Padilha, Lara Delgado
Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Lisbon, Portugal
Click here for correspondence address and email
| Date of Submission | 11-Jan-2022 |
| Date of Decision | 20-Jan-2022 |
| Date of Acceptance | 27-Jan-2022 |
| Date of Web Publication | 03-May-2022 |
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| Section 2 – Answer | |  |
Case
A 55-year-old woman, presented in your hospital with renal dysfunction of unknown cause, 2 years after renal graft. A percutaneous renal biopsy was done and protocol 24-h postbiopsy ultrasound (US) with Doppler was performed (see the figures below). What is your interpretation/diagnosis?
| Interpretation | | |
In the lower pole of the renal graft, we observe an anechogenic image, which fills with color in the color Doppler [Figure 1]. | Figure 1: Lower pole of the renal graft with color Doppler and grayscale ultrasound
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With the spectral Doppler US [Figure 2], there is a clear increase of velocity of the systolic peak (vs.), turbulent flow, and also a reduction of the resistance index. | Figure 2: Lower pole of the renal graft with color Doppler and spectral Doppler
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These aspects are compatible with an arteriovenous fistula, a complication of the graft biopsy.
| Discussion | | |
Percutaneous biopsy is commonly performed in grafts when rejection is suspected. The most common complications are prolonged gross hematuria, perirenal hematoma, intrarenal arteriovenous fistula, and pseudoaneurysm.[1],[2],[3]
Most of the arteriovenous fistulas are small and self-limiting, with no symptoms, such as in our case. Although in some cases, large or persistent arteriovenous fistulas are may cause hematuria, dysfunction, vascular ischemia, and high output heart failure due to the steal phenomenon.
Arteriovenous fistulas are easily identified in the US. They appear as localized areas of disorganized color that extend outside the confines of the normal vessel due to the vibration in the tissue that surrounds the fistula. Arteriovenous fistulas also appear as abnormal high-velocity turbulent flow isolated to a single segmental or interlobar artery and paired vein that produces aliasing on color Doppler images. In large fistulas, which was not our case, the feeding artery shows a high-velocity low-resistance waveform, and the draining vein demonstrates arterialization.[2],[3]
Most complications after biopsy are treated conservatively.[1],[2],[3]
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
The other authors declared no conflicts of interest in writing this article.
| References | | |
| 1. | Tapia-Canelas C, Zometa R, López-Oliva MO, Jiménez C, Rivas B, Escuin F, et al. Complicaciones asociadas a la biopsia de injertos renales en pacientes trasplantados [Complications associated with renal graft biopsy in transplant patients]. Nefrologia. 2014;34(1):115-9. Spanish  |
| 2. | Inci MF, Ozkan F, See TC, Tatli S. Renal transplant complications: diagnostic and therapeutic role of radiology. Can Assoc Radiol J 2014;65:242-52. |
| 3. | Akbar SA, Jafri SZ, Amendola MA, Madrazo BL, Salem R, Bis KG. Complications of renal transplantation. Radiographics 2005;25:1335-56. |
Correspondence Address:
Carolina Cairrão Padilha,
Department of Radiology, Centro Hospitalar de Lisboa Ocidental, Estrada Forte do alto Duque, 1449-005, Lisbon
Portugal
 Source of Support: None, Conflict of Interest: None
[Figure 1], [Figure 2] |
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