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Vesicoureteral reflux to the non-functional graft on a renal transplant imaging with 99mTc-DTPA
ARTICLE IN PRESS Rev Esp Med Nucl. 2009;28(6):305–306
Interesting images
Vesicoureteral reflux to the non-functional graft on a renal transplant imaging with 99mTc-DTPA Reflujo vesicoureteral a un injerto no-funcional en un estudio de ima´genes con 99mTc-DTPA de un transplante renal R. Sadeghi, A. Javad, R. Zakavi and V.R. Dabbagh Kakhki Nuclear Medicine Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Figura 1. 99mTc-DTPA renal transplant imaging. The scan showed normal function of the new graft on the left side of the image. Abnormal activity in the location of the previous non-functional graft gradually appeared (arrow).
Corresponding author.
E-mail address: [email protected] (V.R. Dabbagh Kakhki). ˜ a, S.L. y SEMN. Todos los derechos reservados. 0212-6982/$ - see front matter & 2009 Elsevier Espan doi:10.1016/j.remn.2009.07.005
ARTICLE IN PRESS 306
R. Sadeghi et al. / Rev Esp Med Nucl. 2009;28(6):305–306
Figura 2. Direct radionuclide cystography of the patient which showed vesicoureteral reflux into both new (black arrow) and non-functional (hollow arrow) grafts. The images are taken in anterior projection.
Renal functional scintigraphy is an integral part of transplant kidney follow up1. Reflux to the transplant kidney is a common complication which can occur early after graft surgery2,3. We report a 43 year old male patient with end-stage renal disease who received a transplant kidney 13 years ago. Gradually the transplant function decreased due to chronic rejection and finally the graft became nonfunctional. The patient underwent another transplant surgery and received another graft. Renal scintigraphy with 99mTc-DTPA was performed and in addition to the new graft, abnormal activity in the location of the previous graft was seen gradually (fig. 1). Direct radionuclide cystography was performed with the suspicion of vesicoureteral reflux. Vesicoureteral reflux to both new and nonfunctional grafts was prominent (fig. 2). We recommend considering
vesiocureteral reflux when interpreting renal transplant scintigraphy, since it can be mistaken with other complications such as urine leak.
References 1. Banzo I, Quirce R, Martı´nez-Rodrı´guez I, Jime´nez-Bonilla J, Sainz A, Carril JM. Atlas of isotopic renography images in the renal transplant complications. Rev Esp Med Nucl. 2006;25:329–48. 2. Nguyen BD, Roarke MC. Scintigraphic demonstration of transplant perfusion compromise with calyceal reflux. Clin Nucl Med. 2008;33:513–4. 3. Jung GO, Chun JM, Park JB, Choi GS, Kwon CH, Joh JW, et al. Clinical significance of posttransplantation vesicoureteral reflux during short-term period after kidney transplantation. Transplant Proc. 2008;40:2339–41.
Interesting images
Vesicoureteral reflux to the non-functional graft on a renal transplant imaging with 99mTc-DTPA Reflujo vesicoureteral a un injerto no-funcional en un estudio de ima´genes con 99mTc-DTPA de un transplante renal R. Sadeghi, A. Javad, R. Zakavi and V.R. Dabbagh Kakhki Nuclear Medicine Department, Imam Reza Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
Figura 1. 99mTc-DTPA renal transplant imaging. The scan showed normal function of the new graft on the left side of the image. Abnormal activity in the location of the previous non-functional graft gradually appeared (arrow).
Corresponding author.
E-mail address: [email protected] (V.R. Dabbagh Kakhki). ˜ a, S.L. y SEMN. Todos los derechos reservados. 0212-6982/$ - see front matter & 2009 Elsevier Espan doi:10.1016/j.remn.2009.07.005
ARTICLE IN PRESS 306
R. Sadeghi et al. / Rev Esp Med Nucl. 2009;28(6):305–306
Figura 2. Direct radionuclide cystography of the patient which showed vesicoureteral reflux into both new (black arrow) and non-functional (hollow arrow) grafts. The images are taken in anterior projection.
Renal functional scintigraphy is an integral part of transplant kidney follow up1. Reflux to the transplant kidney is a common complication which can occur early after graft surgery2,3. We report a 43 year old male patient with end-stage renal disease who received a transplant kidney 13 years ago. Gradually the transplant function decreased due to chronic rejection and finally the graft became nonfunctional. The patient underwent another transplant surgery and received another graft. Renal scintigraphy with 99mTc-DTPA was performed and in addition to the new graft, abnormal activity in the location of the previous graft was seen gradually (fig. 1). Direct radionuclide cystography was performed with the suspicion of vesicoureteral reflux. Vesicoureteral reflux to both new and nonfunctional grafts was prominent (fig. 2). We recommend considering
vesiocureteral reflux when interpreting renal transplant scintigraphy, since it can be mistaken with other complications such as urine leak.
References 1. Banzo I, Quirce R, Martı´nez-Rodrı´guez I, Jime´nez-Bonilla J, Sainz A, Carril JM. Atlas of isotopic renography images in the renal transplant complications. Rev Esp Med Nucl. 2006;25:329–48. 2. Nguyen BD, Roarke MC. Scintigraphic demonstration of transplant perfusion compromise with calyceal reflux. Clin Nucl Med. 2008;33:513–4. 3. Jung GO, Chun JM, Park JB, Choi GS, Kwon CH, Joh JW, et al. Clinical significance of posttransplantation vesicoureteral reflux during short-term period after kidney transplantation. Transplant Proc. 2008;40:2339–41.