Age: 36
Sex: Female
Indication: Left lower quadrant pain, shortness of breath
History: Right ovarian cancer status post en bloc resection of the mass including a portion of the right ureter, cytoreductive surgery, more recent left lower quadrant renal transplant
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Case #90
Findings
- Chest
- Mild enlargement of several left supraclavicular lymph nodes, with index nodes measuring up to 11 mm in short axis
- No enlarged axillary, mediastinal, or hilar lymph nodes
- Right IJ approach Port-A-Cath with catheter tip extending across the plane of the tricuspid valve into the right ventricle
- Tunneled left IJ approach dialysis catheter with tip in the inferior aspect of the right atrium near the inferior cavoatrial junction
- Mild dependent atelectasis/scarring
- No suspicious pulmonary nodules
- Small right pleural effusion
- No pneumothorax
- Abdomen/Pelvis
- Enlarged left lower quadrant transplant kidney with diffuse hypoenhancement with the exception of a preserved rim of cortical enhancement
- The transplant renal vein is not well visualized in the renal hilum, though the transplant renal artery and its proximal branches appear patent
- Severe right hydronephrosis and proximal right hydroureter with an abrupt caliber change in the mid right ureter
- Punctate nonobstructing right renal calculus
- Surgical changes of retroperitoneal lymphadenectomy. No enlarged retroperitoneal lymph nodes
- Mild presacral soft tissue thickening, likely treatment related
- Small volume nonloculated ascites
- Surgical changes of omentectomy
- Surgical changes of hysterectomy and bilateral salpingo-oophorectomy
- Heterogeneous enhancement of the liver parenchyma with multiple areas of wedge-shaped peripheral hypoattenuation
- Mil diffuse pancreatic atrophy
- Atherosclerotic calcification of the abdominal aorta and branch vessels, particularly affecting medium and small-sized arteries, without aneurysm
- MSK
- No acute osseous findings
- Mild body wall edema
- Ventral laparotomy changes
Diagnosis
- Transplant renal vein thrombosis
Sample Report
Marked enlargement of the left lower quadrant transplant kidney with findings concerning for transplant renal vein thrombosis and developing renal infarction. Recommend urgent evaluation by transplant surgery.
Surgical changes following en bloc resection of a pelvic mass, cytoreductive debulking, and retroperitoneal lymphadenectomy. No findings specific for recurrent neoplasm in the abdomen or pelvis. Nonspecific mildly enlarged left supraclavicular lymph nodes which can be further assessed on followup imaging or PET/CT.
Severe right hydronephrosis and proximal hydroureter with abrupt caliber change in the mid right ureter, which may represent a postoperative stricture.
Heterogeneous hepatic parenchymal attenuation with multiple areas of wedge-shaped peripheral hypoattenuation, which may relate to hepatic congestion or altered hepatic perfusion, though hepatic infarcts could have a similar appearance. No findings highly concerning for hepatic metastatic disease.
Right IJ approach Port-A-Cath with catheter tip extending across the plane of the tricuspid valve into the right ventricle. Catheter repositioning should be considered.
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