IMAGE QUIZ

The answer to the image quiz dated June 5, 2012 is chronic rejection–renal transplant. The ultrasound image shows diffusely increased parenchymal echogenicity. US-guided core biopsy confirmed chronic rejection. Calipers (+) measure the length of the transplant kidney.

The Question

The image is from an ultrasound examination of a transplanted kidney in a patient with gradually increasing serum creatinine. What's the diagnosis?

 

Explanation

Chronic rejection is the most common cause of late transplant loss. Loss of renal function is progressive to complete transplant failure. An ultrasound usually shows diminished renal size, thinning of the cortex, and often mild hydronephrosis.

(Source William E. Brant M.D., Core Curriculum, The Ultrasound, 
1st Edition Lippincott Williams & Wilkins 2001)