Imaging after renal transplantation

Traumatic Renal Transplant Subcapsular Hematoma: Diagnosis by Duplex Ultrasound

Introduction

Subcapsular renal hematomas result from a hemorrhage within the kidney that is contained by its fibrous capsule. In some cases, enlarging or acute hematomas may compress the renal parenchyma and result in ischemia or impaired renal function. In the renal transplant recipient or a patient with a solitary kidney, this situation requires immediate identification and aggressive intervention to preserve renal function.

Patient

A 54-year-old renal transplant recipient was seen in our vascular laboratory with complaints of severe pain over his transplanted kidney, hematuria, and an elevated creatinine level. His recent history was significant for a minor automobile accident in which his seatbelt engaged over the site of his transplant in the right iliac fossa.

Findings

Gray-scale imaging revealed a reniform collection surrounding the lateral surface of the kidney, displacing and compressing the renal parenchyma. Resistive indices were elevated at 1.0 throughout the transplant. At the hilum of the kidney, color Doppler documented a high-velocity flow jet in the main renal vein with a continuous Doppler flow pattern. On the basis of these findings, the patient was taken to the operating room for emergent evacuation of the hematoma. A follow-up duplex ultrasonography on the first postoperative day revealed a significant decrease in the size of the hematoma. The resistive indices and the renal vein flow returned to normal.

Conclusion

Duplex ultrasonography provided an accurate diagnosis of the subcapsular hematoma and its hemodynamic impact on the transplanted kidney.