RENAL TRANSPLANTS: A PICTORIAL REVIEW OF ULTRASOUND CASES
By Victoria Cushway, Portsmouth Hospitals University NHS Trust
Introduction:
Ultrasound is used in the evaluation of renal transplants as it is non-invasive, easily accessible and non-nephrotoxic. Ultrasound can provide information on structure and function of the renal transplant using B-mode and Doppler. There are 25 NHS kidney transplant units in the UK (NHS Blood and Transplant, 2024), therefore ultrasound examinations of transplant kidneys may not occur as frequently in all clinics as patients are directed to specialist units. This poster is a pictorial review of interesting ultrasound cases involving transplant kidneys, aiming to discuss and analyse image interpretation of related pathologies.
Explanation:
The use of ultrasound in the evaluation of renal transplants is crucial, especially in the immediate post-operative period, in order to identify any complications which may require urgent intervention to protect the function of the transplant (BMUS, 2021). It is essential that the radiology team make a prompt, accurate diagnosis and work together with the renal team to achieve the best possible outcome for the patient, as this may be time critical. This poster will feature ultrasound imaging examples from a kidney transplant centre, comprising of interesting cases, common pathologies, as well as, a case to learn from demonstrating a pitfall. Ultrasound image interpretation and technique will be discussed and evaluated to support best practice.
A 56-year old man was diagnosed with stage IIIC melanoma. A wide local excision and sentinel node biopsy was performed which was positive. As a result, CT and ultrasound scans were performed at regular intervals after diagnosis and staging.
Ultrasound findings:
The first ultrasound scan performed 4 months post-diagnosis was normal. However, 8 months post-diagnosis, an abnormal lymph node was detected on ultrasound. This lymph node had suspicious features indicating malignancy. CT identified this atypical lymph node also and showed prominent mesenteric lymph nodes concerning for metastasis. A biopsy was performed on the node detected by ultrasound which confirmed the return of metastatic malignant melanoma.
Discussion:
Despite the excellent accuracy of ultrasound in detecting melanoma recurrence at the nodal basin, this service is only available in two hospitals in the Republic of Ireland. There are a number of barriers which inhibit its availability including the lack of specialised training and doubt regarding the need if regular cross-sectional imaging is performed.
Conclusion:
This case demonstrates how sensitive and specific ultrasound can be in identifying abnormal lymph nodes suspicious of metastatic melanoma recurrence. However, accuracy depends on the sonographer’s skill. Hence, more training must be provided in order to make this service available at more clinical sites.