Aim of This Study: This study aims to describe the utility of high-resolution computed tomography... more Aim of This Study: This study aims to describe the utility of high-resolution computed tomography (HRCT) of chest in renal transplant recipients in patients with pulmonary infection. Materials and Methods: We retrospectively analyzed the findings of HRCT of chest in 48 postrenal transplant patients with documented pulmonary infection from September 2013 to August 2014. All patients underwent detailed investigations including specific pathological tests, chest X-ray, sputum analysis, bronchoalveolar lavage and pleural fluid analysis as and when required. HRCT was done in all patients on Somatom sensation 64 scan. The spectrum of causative organism and utility of HRCT was studied. Results: Out of 48 patients, the causative organism was confirmed by microbiology in 27 patients. These include 14 patients with Gram-negative bacteria, 5 patients with Gram-positive bacteria, 8 patients with fungal infection, and 3 patients with Mycobacterium tuberculosis infection confirmed on sputum analysis. The causative organism was confirmed to be cytomegalovirus-based on serological tests in 3 patients. Laboratory investigations could not identify the causative organism in 18 patients, 2 of them were treated with broad spectrum antibiotic, 13 patients with anti-tuberculous drugs, and 3 patients with antifungal therapy based on CT findings. Spectrum of HRCT findings was studied. Conclusion: We found bacterial infection is the most common in postrenal transplant patients followed by M. tuberculosis. Tree in bud appearance is common in M. tuberculosis infection. We found HRCT makes the road of early diagnosis of pulmonary infections smoother when coupled with clinical data.
Lymphocele is one of the most common complications following renal transplantation and can lead t... more Lymphocele is one of the most common complications following renal transplantation and can lead to an increase in morbidity. Its incidence has been reported to vary from 0.6% to 20%. The use of ultrasonography has increased the index of detection of lymphocele though the majority of them have small size and resolved spontaneously. We describe a case of a postrenal transplant patient who developed anuria due to transplanted ureteric compression by lymphocele in deceased donor dual-renal transplantation in the right renal fossa. When a transplanted patient comes with a history of sudden anuria, one should consider ureteric compression resulting from lymphocele as a possible cause.
Journal of clinical and diagnostic research : JCDR, 2016
Congenital anomalies of the Inferior Vena Cava (IVC) result from the persistence of the embryonic... more Congenital anomalies of the Inferior Vena Cava (IVC) result from the persistence of the embryonic venous system. Knowledge of such anomaly is of great importance during abdominal surgery, liver and kidney transplantation, renal venous sampling and in the treatment of thromboembolic diseases. Here, we report a rare anatomical variation of dual IVC with normal course of right sided IVC and hemiazygous continuation of left sided IVC with interiliac communication in potential renal donor. Congenital abnormalities of the inferior vena cava are easily identified on Computed Tomography (CT) and should be considered when interpreting any CT of the abdomen or chest.
Renal arteriovenous malformations are abnormal communications between the intrarenal arterial and... more Renal arteriovenous malformations are abnormal communications between the intrarenal arterial and venous systems. They are a rare cause of hematuria. Color Doppler ultrasonography, multislice CT angiography, and DSA are important tools for making the diagnosis. We describe the case of a 62-year-old man with renal arteriovenous malformation who presented with gross hematuria.
We report a rare case of isolated spontaneous renal artery dissection treated by stent placement.... more We report a rare case of isolated spontaneous renal artery dissection treated by stent placement. A 59-year-old man presented with a sudden onset of left flank pain and severe hypertension together with elevated creatinine levels. A computed tomography scan revealed a focal dissection at the left renal artery (LRA) with an infarcted left kidney. Despite medical treatment with 4 drugs, the patient's blood pressure remained uncontrolled. Angiography confirmed the diagnosis. A 6- × 60-mm Xpert stent (Abbott Vascular, Temecula, CA) was deployed at the LRA, achieving an enlarged true lumen with a patent stent. After the procedure, acute renal impairment was observed but pain subsided and blood pressure normalized under the treatment prescribed. At 12 months of follow-up, the patient was normotensive and asymptomatic with mild chronic renal failure and a patent LRA stent on doppler ultrasonography. The endovascular treatment of isolated spontaneous renal artery dissection appears to be feasible and effective and could be the first-line treatment when revascularization is needed.
A 73-YR-OLD man presented for lung resection. Medical history included hypertension and coronary ... more A 73-YR-OLD man presented for lung resection. Medical history included hypertension and coronary artery disease. Using the over-the-needletechnique, a 20-G angiocatheter was inserted in the left radial artery with one attempt for monitoring. It was removed 2 days later. The following day, erythema and induration appeared at the puncture site (fig. A). Wound cultures grew Staphylococcus aureus. An ultrasound was performed and a pseudoaneurysm was detected (fig. B). The patient underwent surgical resection of the pseudoaneurysm (fig. C) without sequelae to the involved upper extremity. With a reported incidence of 0.048%, 1 radial artery pseudoaneurysm is a rare but serious complication of arterial cannulation, a commonly performed procedure in anesthesia practice. In contrast to a true aneurysm, which involves dilatation of all layers of the arterial wall, a pseudoaneurysm is a collection of blood that communicates with the arterial lumen without being enclosed by the arterial wall. On ultrasound, swirling blood flow is seen within the pulsatile mass. 2 Its pathogenesis involves trauma to the arterial wall and catheter site infection. Prolonged duration of catheterization and length of hospitalization have been shown to be risk factors for developing catheter-related infections. Risk factors for pseudoaneurysm formation include S. aureus infection and persistent bacteremia after catheter removal. 3 Delayed diagnosis may lead to compression ischemia and sepsis. Once a pseudoaneurysm has formed, surgical treatment is usually needed because conservative management carries a high risk of complications such as pseudoaneurysm rupture and thrombus propagation.
This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
Aim of This Study: This study aims to describe the utility of high-resolution computed tomography... more Aim of This Study: This study aims to describe the utility of high-resolution computed tomography (HRCT) of chest in renal transplant recipients in patients with pulmonary infection. Materials and Methods: We retrospectively analyzed the findings of HRCT of chest in 48 postrenal transplant patients with documented pulmonary infection from September 2013 to August 2014. All patients underwent detailed investigations including specific pathological tests, chest X-ray, sputum analysis, bronchoalveolar lavage and pleural fluid analysis as and when required. HRCT was done in all patients on Somatom sensation 64 scan. The spectrum of causative organism and utility of HRCT was studied. Results: Out of 48 patients, the causative organism was confirmed by microbiology in 27 patients. These include 14 patients with Gram-negative bacteria, 5 patients with Gram-positive bacteria, 8 patients with fungal infection, and 3 patients with Mycobacterium tuberculosis infection confirmed on sputum analysis. The causative organism was confirmed to be cytomegalovirus-based on serological tests in 3 patients. Laboratory investigations could not identify the causative organism in 18 patients, 2 of them were treated with broad spectrum antibiotic, 13 patients with anti-tuberculous drugs, and 3 patients with antifungal therapy based on CT findings. Spectrum of HRCT findings was studied. Conclusion: We found bacterial infection is the most common in postrenal transplant patients followed by M. tuberculosis. Tree in bud appearance is common in M. tuberculosis infection. We found HRCT makes the road of early diagnosis of pulmonary infections smoother when coupled with clinical data.
Lymphocele is one of the most common complications following renal transplantation and can lead t... more Lymphocele is one of the most common complications following renal transplantation and can lead to an increase in morbidity. Its incidence has been reported to vary from 0.6% to 20%. The use of ultrasonography has increased the index of detection of lymphocele though the majority of them have small size and resolved spontaneously. We describe a case of a postrenal transplant patient who developed anuria due to transplanted ureteric compression by lymphocele in deceased donor dual-renal transplantation in the right renal fossa. When a transplanted patient comes with a history of sudden anuria, one should consider ureteric compression resulting from lymphocele as a possible cause.
Journal of clinical and diagnostic research : JCDR, 2016
Congenital anomalies of the Inferior Vena Cava (IVC) result from the persistence of the embryonic... more Congenital anomalies of the Inferior Vena Cava (IVC) result from the persistence of the embryonic venous system. Knowledge of such anomaly is of great importance during abdominal surgery, liver and kidney transplantation, renal venous sampling and in the treatment of thromboembolic diseases. Here, we report a rare anatomical variation of dual IVC with normal course of right sided IVC and hemiazygous continuation of left sided IVC with interiliac communication in potential renal donor. Congenital abnormalities of the inferior vena cava are easily identified on Computed Tomography (CT) and should be considered when interpreting any CT of the abdomen or chest.
Renal arteriovenous malformations are abnormal communications between the intrarenal arterial and... more Renal arteriovenous malformations are abnormal communications between the intrarenal arterial and venous systems. They are a rare cause of hematuria. Color Doppler ultrasonography, multislice CT angiography, and DSA are important tools for making the diagnosis. We describe the case of a 62-year-old man with renal arteriovenous malformation who presented with gross hematuria.
We report a rare case of isolated spontaneous renal artery dissection treated by stent placement.... more We report a rare case of isolated spontaneous renal artery dissection treated by stent placement. A 59-year-old man presented with a sudden onset of left flank pain and severe hypertension together with elevated creatinine levels. A computed tomography scan revealed a focal dissection at the left renal artery (LRA) with an infarcted left kidney. Despite medical treatment with 4 drugs, the patient's blood pressure remained uncontrolled. Angiography confirmed the diagnosis. A 6- × 60-mm Xpert stent (Abbott Vascular, Temecula, CA) was deployed at the LRA, achieving an enlarged true lumen with a patent stent. After the procedure, acute renal impairment was observed but pain subsided and blood pressure normalized under the treatment prescribed. At 12 months of follow-up, the patient was normotensive and asymptomatic with mild chronic renal failure and a patent LRA stent on doppler ultrasonography. The endovascular treatment of isolated spontaneous renal artery dissection appears to be feasible and effective and could be the first-line treatment when revascularization is needed.
A 73-YR-OLD man presented for lung resection. Medical history included hypertension and coronary ... more A 73-YR-OLD man presented for lung resection. Medical history included hypertension and coronary artery disease. Using the over-the-needletechnique, a 20-G angiocatheter was inserted in the left radial artery with one attempt for monitoring. It was removed 2 days later. The following day, erythema and induration appeared at the puncture site (fig. A). Wound cultures grew Staphylococcus aureus. An ultrasound was performed and a pseudoaneurysm was detected (fig. B). The patient underwent surgical resection of the pseudoaneurysm (fig. C) without sequelae to the involved upper extremity. With a reported incidence of 0.048%, 1 radial artery pseudoaneurysm is a rare but serious complication of arterial cannulation, a commonly performed procedure in anesthesia practice. In contrast to a true aneurysm, which involves dilatation of all layers of the arterial wall, a pseudoaneurysm is a collection of blood that communicates with the arterial lumen without being enclosed by the arterial wall. On ultrasound, swirling blood flow is seen within the pulsatile mass. 2 Its pathogenesis involves trauma to the arterial wall and catheter site infection. Prolonged duration of catheterization and length of hospitalization have been shown to be risk factors for developing catheter-related infections. Risk factors for pseudoaneurysm formation include S. aureus infection and persistent bacteremia after catheter removal. 3 Delayed diagnosis may lead to compression ischemia and sepsis. Once a pseudoaneurysm has formed, surgical treatment is usually needed because conservative management carries a high risk of complications such as pseudoaneurysm rupture and thrombus propagation.
This is an open access article distributed under the terms of the Creative Commons Attribution-No... more This is an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 3.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as the author is credited and the new creations are licensed under the identical terms.
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