Kidney transplant - Thrombosis, Emphysematous Pyelonephritis and Abscessification
50 year old male patient with history of end-stage renal disease secondary to ADPKD, who underwent kidney transplant in the right iliac fossa. In the first week after the surgery an arterial and venous thrombosis of the graft was diagnosed by Doppler US and CT. Surgical removal of the graft was posposed because of a clinically diagnosed prostatitis. 2 weeks later presents fever and pelvic pain, with blood tests showing leukopenia and anemia. A CT scan was performed.
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Portal-venous phase CT scan shows enlarged native kidneys in a patient with ADPKD. Right iliac fossa graft shows no vascularization in relation to previously known arterial and venous thrombosis. There is air in the excretory system of the trasplant and a peri-renal fluid collection with air and enhancing walls. The findings were reported as a perirrenal abscess, possible secondary to emphysematous pyelonephritis of the graft.
Because of the CT findings a percutaneous drainage was performed, obtaining 100cc of purulent fluid consistent with the suspicion of perirenal abscess.
Emphysematous pyelonephritis is an uncommon severe infection of the kidney, usually seen in diabetic but also in immunocompromised patients. In this case, there was leukopenia and the patient was still undergoing immunosuppresive therapy because of the transplant. If left untreated, carries a high risk of sepsis and death.