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Photopenic defect within transplanted kidney
GAMUT
Photopenic Defect Within Transplanted Kidney Frank W. Sanchez, Leonie Gordon, and Nancy S. Curry
H R E E W E E K S after discharge status postcadaveric renal transplant with a 2-antigen match, a 32-year-old man was readmitted with fever and chills. The transplant was noted to be nontender despite a fever of 104.5 ~ Lab exam revealed white blood cell count (WBC) of 14,000 with 21 to 50 WBCs in the urine. Technetium-99m D T P A (diethylenetriamine penta-acetic acid) examination was performed and revealed a new round photopenic area in the upper pole of the transplant (Fig 1A), not present on the previous study (Fig 1B), and verified by ultrasound. Under ultrasonic guidance, the lesion was aspirated and yielded 7 cm 3 of pus that subsequently grew Escherichia coli.
T
From the Department of Radiology, Medical University of South Carolina, Charleston, SC. Address reprint requests to Dr Gordon, Department of Radiology, Medical University of South Carolina, 171 Ashley Ave, Charleston. SC 29425. 9 1984 by Grune & Stratton, Inc. 0001-2998/84/1404~9007505.00/0
COMMON A b s c e s s 1.2
Cyst within transplanted kidney 3'4 Hydrocalyx ~'4 Localized infarct ~-4 Segmental pyelonephritis 4'5 UNCOMMON
Benign or malignant renal tumors 3'5 Air/fluid or barium filled loops of bowel 1'6 Artifact, eg, coins in pocket ~ Traumatic hematoma or urinoma 2'3's'6 REFERENCES 1. Corcoran R J, Thrall JH, Kaminski R J, et al: Bodybackground defects with 99~Tc-DTPA after renal transplantation: Case Report. J Nucl Med 17:696-698, 1976 2. Ayers JG, Hilson AJW, Maisey MN: Complicatinos of renal transplantation: Appearance using TC-99m-DTPA. Clin Nucl Med 5:473-480, 1980 3. Kirchner PT, Rosenthall L: Renal Transplant evaluation. Semin Nucl Med 11:370-378, 1982 4. Lin DS: Renal cortical defects. Semin Nucl Med 12:396-397, 1982 5. Coyne SS, Walsh JW, Tisnado J, et al: Surgically correctable renal transplant complications: An integrated clinical and radiologic approach. A JR 136:1113 l 119, 1981 6. Lin DS: Cold area around a transplanted kidney. Semin Nucl Med 12:394-395, 1982
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Fig 1. (A) Technetium-99m-DTPA static renal images at ten minutes postadministration shows a large photopenic defect in the upper pole of the transplant. The transplant is functioning well and activity is seen in the ureter and bladder. (B) Technetium-99-DTPA static renal images at ten minutes postadministration obtained t w o weeks prior to (a). Note the normal renal outline with minimal activity seen in the bladder.
342
Seminars in Nuclear Medicine, Vot XlV, No 4 (October), 1984
Photopenic Defect Within Transplanted Kidney Frank W. Sanchez, Leonie Gordon, and Nancy S. Curry
H R E E W E E K S after discharge status postcadaveric renal transplant with a 2-antigen match, a 32-year-old man was readmitted with fever and chills. The transplant was noted to be nontender despite a fever of 104.5 ~ Lab exam revealed white blood cell count (WBC) of 14,000 with 21 to 50 WBCs in the urine. Technetium-99m D T P A (diethylenetriamine penta-acetic acid) examination was performed and revealed a new round photopenic area in the upper pole of the transplant (Fig 1A), not present on the previous study (Fig 1B), and verified by ultrasound. Under ultrasonic guidance, the lesion was aspirated and yielded 7 cm 3 of pus that subsequently grew Escherichia coli.
T
From the Department of Radiology, Medical University of South Carolina, Charleston, SC. Address reprint requests to Dr Gordon, Department of Radiology, Medical University of South Carolina, 171 Ashley Ave, Charleston. SC 29425. 9 1984 by Grune & Stratton, Inc. 0001-2998/84/1404~9007505.00/0
COMMON A b s c e s s 1.2
Cyst within transplanted kidney 3'4 Hydrocalyx ~'4 Localized infarct ~-4 Segmental pyelonephritis 4'5 UNCOMMON
Benign or malignant renal tumors 3'5 Air/fluid or barium filled loops of bowel 1'6 Artifact, eg, coins in pocket ~ Traumatic hematoma or urinoma 2'3's'6 REFERENCES 1. Corcoran R J, Thrall JH, Kaminski R J, et al: Bodybackground defects with 99~Tc-DTPA after renal transplantation: Case Report. J Nucl Med 17:696-698, 1976 2. Ayers JG, Hilson AJW, Maisey MN: Complicatinos of renal transplantation: Appearance using TC-99m-DTPA. Clin Nucl Med 5:473-480, 1980 3. Kirchner PT, Rosenthall L: Renal Transplant evaluation. Semin Nucl Med 11:370-378, 1982 4. Lin DS: Renal cortical defects. Semin Nucl Med 12:396-397, 1982 5. Coyne SS, Walsh JW, Tisnado J, et al: Surgically correctable renal transplant complications: An integrated clinical and radiologic approach. A JR 136:1113 l 119, 1981 6. Lin DS: Cold area around a transplanted kidney. Semin Nucl Med 12:394-395, 1982
9~
~
1
Fig 1. (A) Technetium-99m-DTPA static renal images at ten minutes postadministration shows a large photopenic defect in the upper pole of the transplant. The transplant is functioning well and activity is seen in the ureter and bladder. (B) Technetium-99-DTPA static renal images at ten minutes postadministration obtained t w o weeks prior to (a). Note the normal renal outline with minimal activity seen in the bladder.
342
Seminars in Nuclear Medicine, Vot XlV, No 4 (October), 1984