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“Cold” area around a transplanted kidney
GAMUTS E d i t e d b y R o b e r t C. S t a d a l n i k
"Cold" Area Around a Transplanted Kidney Dorothy S. Lin
A
27-yr-old male was admitted to receive a cadaver kidney transplant because of chronic renal failure since age 19. Four years prior he had received a cadaver kidney transplant to his right iliac fossa. That kidney was removed later due to rejection. Immediately after the current operation, radionuclide renal images showed changes of acute tubular necrosis that gradually resolved in time. Three weeks post operation, the patient's serum creatinine concentration increased, and his urine output declined. 99mTc-Glucoheptonate perfusion and delayed static images showed a persistent "cold" area inferior medial to the lower pole of the transplanted kidney in the left iliac fossa (Figs. 1 and 2). At the same location, the renal ultrasonogram showed a 1 l • 9 x 7 cm
fluid collection. Subsequently, a lymphocele was drained surgically. COMMON
Hematoma j,2 Urinoma ("hot" if extravasated during imaging)~,2
From the Section of Nuclear Medicine, Department of Radiology, University of Mississippi Medical Center, Jackson, Miss. Reprint requests should be addressed to Dorothy S. Lin, M.D., Nuclear Medicine Section, Department of Radiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, Miss. 39216. 9 1982 by Grune & Stratton, Inc. 0001-2998/82/1204~9008501.00/0
%! !, 84184
Fig. 1. Anterior perfusion images of a left renal transplant obtained with SS'Tc-gluc o h e p t o n a t e e v e r y 2 sec. There is a non-perfused "'cold" area inferior medial to the lower renal pole. 394
Seminars in Nuclear Medicine, Vol. XII, No. 4 (October), 1982
"COLD" AREA AROUND A TRANSPLANTED KIDNEY
395
5
10
15
L
Fig. 2. The above mentioned " c o l d " area persisted on t h e static images obtained at 5 minute intervals.
L y m p h o c e l e (usually weeks after t r a n s p l a n t a t i o n ) 1,2 Abscess t,2 H y d r o n e p h r o s i s and h y d r o u r e t e r (prior to t r a c e r filling) ! UNCOMMON P a r t i a l l y nonperfused kidney ~ N o r m a l full u r i n a r y b l a d d e r on early images ~
25 A
N
30 T
Air-, fluid-, or barium-filled loops of overlying bowel ~
REFERENCES 1. Corcoran RJ, Thrall JH, Kaminski RJ, et al: Bodybackground defects with 99~Tc-DTPA after renal transplantation: case report. J Nucl Med 17:696-698, 1976 2. Siegel BA (ed): Nuclear Radiology (Second Series) Syllabus. Chicago, ACR 1978, pp 158-179
"Cold" Area Around a Transplanted Kidney Dorothy S. Lin
A
27-yr-old male was admitted to receive a cadaver kidney transplant because of chronic renal failure since age 19. Four years prior he had received a cadaver kidney transplant to his right iliac fossa. That kidney was removed later due to rejection. Immediately after the current operation, radionuclide renal images showed changes of acute tubular necrosis that gradually resolved in time. Three weeks post operation, the patient's serum creatinine concentration increased, and his urine output declined. 99mTc-Glucoheptonate perfusion and delayed static images showed a persistent "cold" area inferior medial to the lower pole of the transplanted kidney in the left iliac fossa (Figs. 1 and 2). At the same location, the renal ultrasonogram showed a 1 l • 9 x 7 cm
fluid collection. Subsequently, a lymphocele was drained surgically. COMMON
Hematoma j,2 Urinoma ("hot" if extravasated during imaging)~,2
From the Section of Nuclear Medicine, Department of Radiology, University of Mississippi Medical Center, Jackson, Miss. Reprint requests should be addressed to Dorothy S. Lin, M.D., Nuclear Medicine Section, Department of Radiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, Miss. 39216. 9 1982 by Grune & Stratton, Inc. 0001-2998/82/1204~9008501.00/0
%! !, 84184
Fig. 1. Anterior perfusion images of a left renal transplant obtained with SS'Tc-gluc o h e p t o n a t e e v e r y 2 sec. There is a non-perfused "'cold" area inferior medial to the lower renal pole. 394
Seminars in Nuclear Medicine, Vol. XII, No. 4 (October), 1982
"COLD" AREA AROUND A TRANSPLANTED KIDNEY
395
5
10
15
L
Fig. 2. The above mentioned " c o l d " area persisted on t h e static images obtained at 5 minute intervals.
L y m p h o c e l e (usually weeks after t r a n s p l a n t a t i o n ) 1,2 Abscess t,2 H y d r o n e p h r o s i s and h y d r o u r e t e r (prior to t r a c e r filling) ! UNCOMMON P a r t i a l l y nonperfused kidney ~ N o r m a l full u r i n a r y b l a d d e r on early images ~
25 A
N
30 T
Air-, fluid-, or barium-filled loops of overlying bowel ~
REFERENCES 1. Corcoran RJ, Thrall JH, Kaminski RJ, et al: Bodybackground defects with 99~Tc-DTPA after renal transplantation: case report. J Nucl Med 17:696-698, 1976 2. Siegel BA (ed): Nuclear Radiology (Second Series) Syllabus. Chicago, ACR 1978, pp 158-179