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Extraperitoneal urine leak after renal transplantation: the role of radionuclide imaging and the value of accompanying SPECT/CT - a case report

Extraperitoneal urine leak after renal transplantation: the role of radionuclide imaging and the... Background: The differentiation of the nature of a fluid collection as a complication of kidney transplantation is important for management and treatment planning. Early and delayed radionuclide renography can play an important role in the evaluation of a urine leak. However, it is sometimes limited in the evaluation of the exact location and extent of a urine leak. Case Presentation: A 71-year-old male who had sudden anuria, scrotal swelling and elevated creatinine level after cadaveric renal transplantation performed Tc-99 m MAG3 renography to evaluate the renal function, followed by an ultrasound which was unremarkable. An extensive urine leak was evident on the planar images. However, an exact location of the urine leak was unknown. Accompanying SPECT/CT images confirmed a urine leak extending from the lower aspect of the transplant kidney to the floor of the pelvic cavity, presacral region and the scrotum via right inguinal canal as well as to the right abdominal wall. Conclusions: Renal scintigraphy is very useful to detect a urine leak after renal transplantation. However, planar imaging is sometimes limited in evaluating the anatomical location and extent of a urine leak accurately. In that case accompanying SPECT/CT images are very helpful and valuable to evaluate the anatomical relationships exactly. Background definitive diagnosis ultrasound scanning, isotope renal The most effective primary treatment of chronic renal scanning, magnetic resonance urography, antegrade or failure is renal transplantation [1-3]. Most surgical com- retrograde urography, and/or cystography are performed plications involve either the wound or one of the three [7]. An ultrasound plays a crucial role in diagnosis of anastomoses (renal artery, renal vein, or ureter). A fluid postoperative complications, often directly revealing collection is a common complication after kidney trans- fluid collections, dilated collecting systems, and vascular plantation [1,4-6]. Causes of fluid collection include: stenosis [1]. However, an ultrasound cannot differentiate lymphocele, urine leak, hematoma and seroma. Fluid the nature of the collection easily, and such differentia- collections can be asymptomatic, or may be associated tion is important for management and treatment plan- with swelling and pain at the site of the allograft, wound ning. Early and delayed radionuclide renography can drainage, swelling of the ipsilateral lower extremity, and play an important role in the evaluation of a urine leak occult blood loss [4,5]. Approximately two thirds of [8]. However, this is sometimes limited in the evaluation early urologic complications (urine leaks and obstruc- of the exact location of a urine leak. Our case illustrates tion) are apparent in the first month after transplanta- the importance of SPECT/CT imaging in the evaluation tion [6]. It is often difficult to distinguish the signs and of the location and extent of a urine leak which are not symptoms of urinary extravasation from those of rejec- sufficiently revealed on planar renal scintigraphy. tion or obstructive uropathy. To aid in the early and Case Presentation The patient was a 71-year old male with history of diabetes * Correspondence: josef.machac@mssm.edu † Contributed equally mellitus, hypertension, end- stage of renal disease on hemo- The Division of Nuclear Medicine, Department of Radiology, The Mount Sinai dialysis. He underwent cadaveric renal transplantation to School of Medicine, New York, NY, USA © 2010 Son et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Son et al. BMC Medical Imaging 2010, 10:23 Page 2 of 5 http://www.biomedcentral.com/1471-2342/10/23 the right lower abdomen without complications. The early vessels from the renal pedicle, the adjacent lumbar postoperative course was uneventful. The patient main- arteries and the urinary bladder. The last two vascular tained the adequate urine output. The creatinine level supplies are lost when the kidney is removed from the decreased to 1.0. However, on the ninth postoperative day, donor. The vascular supply to the ureter from the renal he experienced sudden pain and swelling in his scrotum, pedicle is tenuous, at best, and easily damaged. With with a drop in a urine output to nearly zero. His creatinine ureteral ischemia the ureter becomes fibrotic and levels abruptly climbed from a nadir of 0.9 to 3.4 over 4 obstructed or breaks down and leaks. days. The patient’s scrotum was markedly dilated with scro- It usually arises at the anastomotic site [4]. Causes tal cutaneous urine leaks. The patient underwent an ultra- other than ischemia include undue tension created by sound examination, showing the normal looking kidney in the short ureter and direct surgical trauma to the ureter the right lower quadrant of the abdomen with normal per- (usually at the time of procurement). Symptoms include fusion and no evidence of hydronephrosis or a perinephric fever, pain, swelling at the graft site, increased creatinine fluid collection. On the next day, the patient underwent level, decreased urine output, and a cutaneous urinary Tc-99 m MAG3 radionuclide renography which showed drainage. normal renal flow and function with a complete drainage The diagnosis of a urine leak after renal transplantation of activity from the renal collecting system to what looked is often made by a combination of clinical findings and like the urinary bladder. In addition, there was an evident imaging studies [8]. The laboratory findings may not be urine leak and an accumulation of radiotracer activity in specific because serum creatinine values do not provide a the pelvic floor extending below the pelvic floor. However, consistent indication of a leak, as they do in cases of the exact location of the urine leak was unknown (Figure obstruction. A leak may result in some systemic reab- 1A and 1B). SPECT/CT imaging of the pelvis was obtained sorption of urine and hence elevated serum creatinine to evaluate the exact location and extent of the urine leak. often mimicking obstruction. Given the difficulty of a The low dose noncontrast CT was obtained for the purpose clinical diagnosis, imaging studies are therefore necessary of anatomic co-registration with the SPECT images. The to substantiate the presence of urine leakage [4,9]. Sono- obtainedSPECT/CTimagesshoweddiffuse extensive graphy and nuclear renography are the most commonly radiotracer activity extending from just below the trans- used imaging studies to diagnose urine leaks [10-12]. plant kidney to the right pelvic cavity next to the urinary Although sonography is excellent at suggesting the possi- bladder, presacral region, right prepubic region and the bility of leakage, the detection of peritransplant fluid by scrotum and penis which were markedly dilated as well as sonography is not specific for a leakage. Although scinti- into the right abdominal wall (Figure 2A and 2B, Figure 3, graphic detection of urine leaks has been well documen- Figure 4). The urinary bladder was totally contracted with a ted and nuclear renography is more helpful in the Foley catheter, from which no radioactivity drained. The diagnosis of larger leaks, it is dependent on good renal structure looked like the urinary bladder on planar renogra- function and limited by poor excretion of the radionu- phy was not the real urinary bladder after all, but an accu- clide in the cases of poor renal function [10-12]. mulation of urine next to the urinary bladder (Fig. 2A). An Our case showed normal renal flow and function of emergency operation was undergone. It revealed a ureteral transplanted kidney with a definite urine leak just below leak secondary to ischemic necrosis of the distal trans- the transplant kidney into the pelvic cavity on the renal planted ureter. A take-down ureteroneocystostomy and scintigraphy. We interpreted a round lesion in the mid- cystorrhaphy, right native ureteroureterostomy with inser- line of pelvic cavity just below the transplanted kidney tion of a stent in the transplant ureter, and right native ure- as a partial filling of the urinary bladder. The exact eva- teroureterostomy to the transplant UVJ were performed. luation of the location of a urine leak was not possible. The postoperative course was uneventful. The obtained SPECT/CT imagesshowed diffuse exten- Ureteral obstruction and extravasation of urine occur sive radiotracer activity to suggest a urine leak just in less than 5% of renal transplants and are usually man- below the transplant kidney extending to the right pelvic ifest more than one week after surgery [4,6]. A post- cavity next to the urinary bladder, presacral region, right transplant urine leakage usually requires invasive prepubic region, and the scrotum and penis which were treatment by either interventional radiology or early sur- markedly dilated as well as into the right abdominal gery [1]. Early surgical exploration with ureteral reim- wall. In other words, SPECT/CT images localized the plantation is indicated for very early leaks, large leaks, anatomical location and extent of leaked urine accu- or leaks that do not respond to conservative measures. rately as well as its anatomical relationship with the The most common cause of ureteral obstruction or a transplant kidney. The extent of a urine leak was much urinary leak is ischemia of the ureter or renal pelvis. greater on SPECT/CT images than that was considered Native ureters have a triple blood supply from blood on planar imaging. In addition, the structure mimicking Son et al. BMC Medical Imaging 2010, 10:23 Page 3 of 5 http://www.biomedcentral.com/1471-2342/10/23 Figure 1 Renal scintigraphy performed immediately after the patient had sudden onset of scrotal swelling and anuria. (A) Initial blood flow images (2 sec/frame) show normal renal perfusion. Here the summed flow images are shown. (B) On subsequent 30-min functional images were obtained. Here the summed functional images demonstrate the transplant kidney showing normal perfusion and function with excretion of radiotracer into the renal collecting system and a focal collection mimicking the urinary bladder (arrows). There is a vertically oriented accumulation of radioactivity inferior to the pelvis (arrow head). Son et al. BMC Medical Imaging 2010, 10:23 Page 4 of 5 http://www.biomedcentral.com/1471-2342/10/23 Figure 2 Coronal images of SPECT/CT of pelvis. (A) The images show a radiotracer accumulation demonstrating a urine leak (arrows) in the right pelvic cavity just next to the urinary bladder and in the scrotum. A Foley catheter balloon is located in the very contracted urinary bladder. (B) More anterior coronal slice shows a urine leak (arrows) in the right pelvic cavity just below the transplanted kidney extending to the scrotum and the right abdominal wall. the urinary bladder was not the urinary bladder, but an localize the urine leak and its extent accurately in the accumulation of urine located in the right pelvic cavity case where it is not possible to see its exact anatomical next to the urinary bladder and right inguinal region. relationship with the adjacent structures and location on We found that SPECT/CT imaging is very useful to planar renal scintigraphy. Figure 3 Axial imagesofSPECT/CTofpelvis. The images show a urine leak (arrows) in the right pelvic cavity next to the urinary bladder extending to the right inguinal canal and abdominal wall anteriorly and the presacral region posteriorly. Son et al. BMC Medical Imaging 2010, 10:23 Page 5 of 5 http://www.biomedcentral.com/1471-2342/10/23 Figure 4 Saggital images of SPECT/CT of pelvis. The images show an accumulation of radiotracer (arrows) in the pelvic floor extending to the presacral region posteriorly, and subcutaneous prepubic region extending to the sacrum inferiorly, and the anterior abdominal wall upwardly. 6. Alavi A, Grossman R, Siegel A: Intraperitoneal urine leak following renal Conclusions transplant: The role of radionuclide imaging. J Nucl Med 1990, Renal scintigraphy is very useful to detect a urine leak 31:1206-1210. after renal transplantation. However, planar imaging is 7. Buresley S, Smahan M, Moniri S, Codaj J, Al-Mousawi M: Postrenal transplantation urologic complications. Trans proc 2008, 40:2345-2346. sometimes limited in evaluating the anatomical location 8. Smith TP, Hunter DW, Letourneau JG, Cragg AH, Darcy MD, Castaneda- and extent of a urine leak accurately. In that case Zuniga WR, Amplatz K: Urine leaks after renal transplantation: Value of accompanying SPECT/CT images are very helpful and percutaneaous pyelography and drainage for diagnosis and treatment. AJR Am J Roentgenol 1988, 151:511-513. valuable to evaluate the anatomical relationships exactly. 9. Yu JQ, Zhuang H, Xiu Y, El-Haddad G, Kumar R, Alavi A: Small urinie leak after renal transplantation: Detection by delayed Tc99 m-DTPA renography-A case report. J Nucl Med Technol 2005, 33:31-33. Acknowledgements 10. Samhan M, Al-Mousawi H, Hayati M, Abdulhalim M, Nampoory MR: Written consent for publication was obtained from the patient. Urologic complications after renal transplantation. Transplant Proc 2005, 37:3075-3076. Authors’ contributions 11. Burgos FJ, Pascual J, Marcen R, García-Navas R, Gómez V, Ortuño J: The role HS participated in the design of the case report and wrote the manuscript of imaging techniques in renal transplantation. World J Urol 2004, and designed the format of figures. SH participated in the sequence 22:399-404. alignment. LK participated in the sequence alignment and collected and 12. Gunatunga I, Facey P, Bartley L, Rees J, Singh S, Fielding P: provided references. JM conceived of the study and participated in its Perinephricurinoma secondary to perforated UPJ obstruction diagnosed design and coordination. All authors read and approved the final using Tc-99 m mercaptoacetyltriglycine (MAG3) SPECT/CT. Clin Nucl Med manuscript. 2007, 32:317-319. Competing interests Pre-publication history The authors declare that they have no competing interests. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2342/10/23/prepub Received: 17 April 2010 Accepted: 20 October 2010 Published: 20 October 2010 doi:10.1186/1471-2342-10-23 Cite this article as: Son et al.: Extraperitoneal urine leak after renal transplantation: the role of radionuclide imaging and the value of References accompanying SPECT/CT - a case report. BMC Medical Imaging 2010 10:23. 1. Park SB, Kim JK, Cho KS: Complications of renal transplantation: ultrasonographic evaluation. J Ultrasound Med 2007, 26:615-633. 2. Baxter GM: Ultrasound of renal transplantation. Clin Radiol 2001, 56:802-818. 3. Mathur VS, Bretan PN Jr, Tomlanovich SJ: Management of end-stage renal disease: transplantation or dialysis. Curr Opin Urol 1994, 4:95-99. 4. Humar A, Matas AJ: Surgical complications after kidney transplantation. Semin Dial 2005, 18:505-510. 5. Englesbe MJ, Dubay DA, Gillespie BW, Moyer AS, Pelletier SJ, Sung RS, Magee JC, Punch JD, Campbell DA Jr, Merion RM: Risk factors for urinary complications after renal transplantation. Am J Transplant 2007, 7:1536-1541. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png BMC Medical Imaging Springer Journals

Extraperitoneal urine leak after renal transplantation: the role of radionuclide imaging and the value of accompanying SPECT/CT - a case report

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Springer Journals
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Copyright © 2010 by Son et al; licensee BioMed Central Ltd.
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Medicine & Public Health; Imaging / Radiology
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Abstract

Background: The differentiation of the nature of a fluid collection as a complication of kidney transplantation is important for management and treatment planning. Early and delayed radionuclide renography can play an important role in the evaluation of a urine leak. However, it is sometimes limited in the evaluation of the exact location and extent of a urine leak. Case Presentation: A 71-year-old male who had sudden anuria, scrotal swelling and elevated creatinine level after cadaveric renal transplantation performed Tc-99 m MAG3 renography to evaluate the renal function, followed by an ultrasound which was unremarkable. An extensive urine leak was evident on the planar images. However, an exact location of the urine leak was unknown. Accompanying SPECT/CT images confirmed a urine leak extending from the lower aspect of the transplant kidney to the floor of the pelvic cavity, presacral region and the scrotum via right inguinal canal as well as to the right abdominal wall. Conclusions: Renal scintigraphy is very useful to detect a urine leak after renal transplantation. However, planar imaging is sometimes limited in evaluating the anatomical location and extent of a urine leak accurately. In that case accompanying SPECT/CT images are very helpful and valuable to evaluate the anatomical relationships exactly. Background definitive diagnosis ultrasound scanning, isotope renal The most effective primary treatment of chronic renal scanning, magnetic resonance urography, antegrade or failure is renal transplantation [1-3]. Most surgical com- retrograde urography, and/or cystography are performed plications involve either the wound or one of the three [7]. An ultrasound plays a crucial role in diagnosis of anastomoses (renal artery, renal vein, or ureter). A fluid postoperative complications, often directly revealing collection is a common complication after kidney trans- fluid collections, dilated collecting systems, and vascular plantation [1,4-6]. Causes of fluid collection include: stenosis [1]. However, an ultrasound cannot differentiate lymphocele, urine leak, hematoma and seroma. Fluid the nature of the collection easily, and such differentia- collections can be asymptomatic, or may be associated tion is important for management and treatment plan- with swelling and pain at the site of the allograft, wound ning. Early and delayed radionuclide renography can drainage, swelling of the ipsilateral lower extremity, and play an important role in the evaluation of a urine leak occult blood loss [4,5]. Approximately two thirds of [8]. However, this is sometimes limited in the evaluation early urologic complications (urine leaks and obstruc- of the exact location of a urine leak. Our case illustrates tion) are apparent in the first month after transplanta- the importance of SPECT/CT imaging in the evaluation tion [6]. It is often difficult to distinguish the signs and of the location and extent of a urine leak which are not symptoms of urinary extravasation from those of rejec- sufficiently revealed on planar renal scintigraphy. tion or obstructive uropathy. To aid in the early and Case Presentation The patient was a 71-year old male with history of diabetes * Correspondence: josef.machac@mssm.edu † Contributed equally mellitus, hypertension, end- stage of renal disease on hemo- The Division of Nuclear Medicine, Department of Radiology, The Mount Sinai dialysis. He underwent cadaveric renal transplantation to School of Medicine, New York, NY, USA © 2010 Son et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Son et al. BMC Medical Imaging 2010, 10:23 Page 2 of 5 http://www.biomedcentral.com/1471-2342/10/23 the right lower abdomen without complications. The early vessels from the renal pedicle, the adjacent lumbar postoperative course was uneventful. The patient main- arteries and the urinary bladder. The last two vascular tained the adequate urine output. The creatinine level supplies are lost when the kidney is removed from the decreased to 1.0. However, on the ninth postoperative day, donor. The vascular supply to the ureter from the renal he experienced sudden pain and swelling in his scrotum, pedicle is tenuous, at best, and easily damaged. With with a drop in a urine output to nearly zero. His creatinine ureteral ischemia the ureter becomes fibrotic and levels abruptly climbed from a nadir of 0.9 to 3.4 over 4 obstructed or breaks down and leaks. days. The patient’s scrotum was markedly dilated with scro- It usually arises at the anastomotic site [4]. Causes tal cutaneous urine leaks. The patient underwent an ultra- other than ischemia include undue tension created by sound examination, showing the normal looking kidney in the short ureter and direct surgical trauma to the ureter the right lower quadrant of the abdomen with normal per- (usually at the time of procurement). Symptoms include fusion and no evidence of hydronephrosis or a perinephric fever, pain, swelling at the graft site, increased creatinine fluid collection. On the next day, the patient underwent level, decreased urine output, and a cutaneous urinary Tc-99 m MAG3 radionuclide renography which showed drainage. normal renal flow and function with a complete drainage The diagnosis of a urine leak after renal transplantation of activity from the renal collecting system to what looked is often made by a combination of clinical findings and like the urinary bladder. In addition, there was an evident imaging studies [8]. The laboratory findings may not be urine leak and an accumulation of radiotracer activity in specific because serum creatinine values do not provide a the pelvic floor extending below the pelvic floor. However, consistent indication of a leak, as they do in cases of the exact location of the urine leak was unknown (Figure obstruction. A leak may result in some systemic reab- 1A and 1B). SPECT/CT imaging of the pelvis was obtained sorption of urine and hence elevated serum creatinine to evaluate the exact location and extent of the urine leak. often mimicking obstruction. Given the difficulty of a The low dose noncontrast CT was obtained for the purpose clinical diagnosis, imaging studies are therefore necessary of anatomic co-registration with the SPECT images. The to substantiate the presence of urine leakage [4,9]. Sono- obtainedSPECT/CTimagesshoweddiffuse extensive graphy and nuclear renography are the most commonly radiotracer activity extending from just below the trans- used imaging studies to diagnose urine leaks [10-12]. plant kidney to the right pelvic cavity next to the urinary Although sonography is excellent at suggesting the possi- bladder, presacral region, right prepubic region and the bility of leakage, the detection of peritransplant fluid by scrotum and penis which were markedly dilated as well as sonography is not specific for a leakage. Although scinti- into the right abdominal wall (Figure 2A and 2B, Figure 3, graphic detection of urine leaks has been well documen- Figure 4). The urinary bladder was totally contracted with a ted and nuclear renography is more helpful in the Foley catheter, from which no radioactivity drained. The diagnosis of larger leaks, it is dependent on good renal structure looked like the urinary bladder on planar renogra- function and limited by poor excretion of the radionu- phy was not the real urinary bladder after all, but an accu- clide in the cases of poor renal function [10-12]. mulation of urine next to the urinary bladder (Fig. 2A). An Our case showed normal renal flow and function of emergency operation was undergone. It revealed a ureteral transplanted kidney with a definite urine leak just below leak secondary to ischemic necrosis of the distal trans- the transplant kidney into the pelvic cavity on the renal planted ureter. A take-down ureteroneocystostomy and scintigraphy. We interpreted a round lesion in the mid- cystorrhaphy, right native ureteroureterostomy with inser- line of pelvic cavity just below the transplanted kidney tion of a stent in the transplant ureter, and right native ure- as a partial filling of the urinary bladder. The exact eva- teroureterostomy to the transplant UVJ were performed. luation of the location of a urine leak was not possible. The postoperative course was uneventful. The obtained SPECT/CT imagesshowed diffuse exten- Ureteral obstruction and extravasation of urine occur sive radiotracer activity to suggest a urine leak just in less than 5% of renal transplants and are usually man- below the transplant kidney extending to the right pelvic ifest more than one week after surgery [4,6]. A post- cavity next to the urinary bladder, presacral region, right transplant urine leakage usually requires invasive prepubic region, and the scrotum and penis which were treatment by either interventional radiology or early sur- markedly dilated as well as into the right abdominal gery [1]. Early surgical exploration with ureteral reim- wall. In other words, SPECT/CT images localized the plantation is indicated for very early leaks, large leaks, anatomical location and extent of leaked urine accu- or leaks that do not respond to conservative measures. rately as well as its anatomical relationship with the The most common cause of ureteral obstruction or a transplant kidney. The extent of a urine leak was much urinary leak is ischemia of the ureter or renal pelvis. greater on SPECT/CT images than that was considered Native ureters have a triple blood supply from blood on planar imaging. In addition, the structure mimicking Son et al. BMC Medical Imaging 2010, 10:23 Page 3 of 5 http://www.biomedcentral.com/1471-2342/10/23 Figure 1 Renal scintigraphy performed immediately after the patient had sudden onset of scrotal swelling and anuria. (A) Initial blood flow images (2 sec/frame) show normal renal perfusion. Here the summed flow images are shown. (B) On subsequent 30-min functional images were obtained. Here the summed functional images demonstrate the transplant kidney showing normal perfusion and function with excretion of radiotracer into the renal collecting system and a focal collection mimicking the urinary bladder (arrows). There is a vertically oriented accumulation of radioactivity inferior to the pelvis (arrow head). Son et al. BMC Medical Imaging 2010, 10:23 Page 4 of 5 http://www.biomedcentral.com/1471-2342/10/23 Figure 2 Coronal images of SPECT/CT of pelvis. (A) The images show a radiotracer accumulation demonstrating a urine leak (arrows) in the right pelvic cavity just next to the urinary bladder and in the scrotum. A Foley catheter balloon is located in the very contracted urinary bladder. (B) More anterior coronal slice shows a urine leak (arrows) in the right pelvic cavity just below the transplanted kidney extending to the scrotum and the right abdominal wall. the urinary bladder was not the urinary bladder, but an localize the urine leak and its extent accurately in the accumulation of urine located in the right pelvic cavity case where it is not possible to see its exact anatomical next to the urinary bladder and right inguinal region. relationship with the adjacent structures and location on We found that SPECT/CT imaging is very useful to planar renal scintigraphy. Figure 3 Axial imagesofSPECT/CTofpelvis. The images show a urine leak (arrows) in the right pelvic cavity next to the urinary bladder extending to the right inguinal canal and abdominal wall anteriorly and the presacral region posteriorly. Son et al. BMC Medical Imaging 2010, 10:23 Page 5 of 5 http://www.biomedcentral.com/1471-2342/10/23 Figure 4 Saggital images of SPECT/CT of pelvis. The images show an accumulation of radiotracer (arrows) in the pelvic floor extending to the presacral region posteriorly, and subcutaneous prepubic region extending to the sacrum inferiorly, and the anterior abdominal wall upwardly. 6. Alavi A, Grossman R, Siegel A: Intraperitoneal urine leak following renal Conclusions transplant: The role of radionuclide imaging. J Nucl Med 1990, Renal scintigraphy is very useful to detect a urine leak 31:1206-1210. after renal transplantation. However, planar imaging is 7. Buresley S, Smahan M, Moniri S, Codaj J, Al-Mousawi M: Postrenal transplantation urologic complications. Trans proc 2008, 40:2345-2346. sometimes limited in evaluating the anatomical location 8. Smith TP, Hunter DW, Letourneau JG, Cragg AH, Darcy MD, Castaneda- and extent of a urine leak accurately. In that case Zuniga WR, Amplatz K: Urine leaks after renal transplantation: Value of accompanying SPECT/CT images are very helpful and percutaneaous pyelography and drainage for diagnosis and treatment. AJR Am J Roentgenol 1988, 151:511-513. valuable to evaluate the anatomical relationships exactly. 9. Yu JQ, Zhuang H, Xiu Y, El-Haddad G, Kumar R, Alavi A: Small urinie leak after renal transplantation: Detection by delayed Tc99 m-DTPA renography-A case report. J Nucl Med Technol 2005, 33:31-33. Acknowledgements 10. Samhan M, Al-Mousawi H, Hayati M, Abdulhalim M, Nampoory MR: Written consent for publication was obtained from the patient. Urologic complications after renal transplantation. Transplant Proc 2005, 37:3075-3076. Authors’ contributions 11. Burgos FJ, Pascual J, Marcen R, García-Navas R, Gómez V, Ortuño J: The role HS participated in the design of the case report and wrote the manuscript of imaging techniques in renal transplantation. World J Urol 2004, and designed the format of figures. SH participated in the sequence 22:399-404. alignment. LK participated in the sequence alignment and collected and 12. Gunatunga I, Facey P, Bartley L, Rees J, Singh S, Fielding P: provided references. JM conceived of the study and participated in its Perinephricurinoma secondary to perforated UPJ obstruction diagnosed design and coordination. All authors read and approved the final using Tc-99 m mercaptoacetyltriglycine (MAG3) SPECT/CT. Clin Nucl Med manuscript. 2007, 32:317-319. Competing interests Pre-publication history The authors declare that they have no competing interests. The pre-publication history for this paper can be accessed here: http://www.biomedcentral.com/1471-2342/10/23/prepub Received: 17 April 2010 Accepted: 20 October 2010 Published: 20 October 2010 doi:10.1186/1471-2342-10-23 Cite this article as: Son et al.: Extraperitoneal urine leak after renal transplantation: the role of radionuclide imaging and the value of References accompanying SPECT/CT - a case report. BMC Medical Imaging 2010 10:23. 1. Park SB, Kim JK, Cho KS: Complications of renal transplantation: ultrasonographic evaluation. J Ultrasound Med 2007, 26:615-633. 2. Baxter GM: Ultrasound of renal transplantation. Clin Radiol 2001, 56:802-818. 3. Mathur VS, Bretan PN Jr, Tomlanovich SJ: Management of end-stage renal disease: transplantation or dialysis. Curr Opin Urol 1994, 4:95-99. 4. Humar A, Matas AJ: Surgical complications after kidney transplantation. Semin Dial 2005, 18:505-510. 5. Englesbe MJ, Dubay DA, Gillespie BW, Moyer AS, Pelletier SJ, Sung RS, Magee JC, Punch JD, Campbell DA Jr, Merion RM: Risk factors for urinary complications after renal transplantation. Am J Transplant 2007, 7:1536-1541.

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BMC Medical Imaging – Springer Journals

Published: Oct 20, 2010

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