Diagnostic Ultrasound - Abdomen and Pelvis

Transplant Renal Vein Thrombosis
Diagnoses: Kidney Transplant
IMAGING
• Enlarged, edematous, hypoechoic kidney due to outflow
obstruction
• Absence or decreased color flow in renal vein at hilum
• Patent renal artery early, later the renal artery will
thrombose also
• High systolic arterial peaks with flow reversal in diastole
• Color, power, spectral Doppler US is first-line imaging
modality for complications of renal transplantation
TOP DIFFERENTIAL DIAGNOSES
• Acute, severe rejection or delayed graft function
• Iliac vein thrombosis or renal vein compression
PATHOLOGY
• Surgical injury or technical problem
• Compression by fluid collection
• Hypovolemia, hypercoagulable state
KEY FACTS
• Thrombus propagation from common femoral/external
iliac vein
CLINICAL ISSUES
• Abrupt onset of graft tenderness and swelling, decreased
function
• Usually within 1st week, most commonly within 48 hours of
transplantation
• ≤ 4% of transplants
• Poor prognosis even with prompt diagnosis and
thrombectomy/surgical revision
• May progress to rupture with hemorrhage and
hypovolemia
DIAGNOSTIC CHECKLIST
• Consider renal vein thrombosis when there is a sudden
drop in urine output in early postoperative period
• Reversal of arterial diastolic flow and absence of venous
flow confirms this diagnosis
(Left) Longitudinal power
Doppler ultrasound of the
renal allograft in a patient
who developed pain and
anuria is shown. Minimal color
flow is seen in the allograft
st, which is edematous.
(Right) Longitudinal Doppler
of the same patient shows
abnormal segmental arterial
waveform with narrow
systolic peaks and reversal of
flow ſt in diastole. The renal
vein was thrombosed.
(Left) Longitudinal color
Doppler ultrasound shows
renal vein thrombosis in a
renal allograft. Thrombus can
be seen in the main renal vein
st extending into segmental
veins. Arterial flow ſt was
still detected in the lower
pole. (Right) Longitudinal
color Doppler ultrasound of
the same patient is shown. The
main renal artery st was
patent but the waveform is
abnormal with reversal of
diastolic flow ſt.
572