Presentation
Fevers and right iliac fossa pain.
Patient Data
Large multiloculated hematoma surrounding the right iliac fossa transplant kidney with both subcapsular and perinephric components. The peripheral enhancement is nonspecific although would be consistent with the clinical impression of superimposed infection.
The underlying renal transplant continues to enhance normally, with preserved corticomedullary differentiation. There is no significant transplant hydronephrosis. Bilateral atrophic native kidneys, with a left-sided baggy extrarenal pelvis and a 14 mm cyst in the interpolar region of the right kidney.
Case Discussion
This patient presented to the emergency department with fevers, right iliac fossa pain and increasing lethargy over the last 3 days. She had undergone a live-related renal transplant 12 months ago for reflux nephropathy.
Urine and blood cultures were taken on presentation and she was found to have an ESBL E. coli urinary tract and blood stream infection. We did a renal biopsy to exclude rejection in the setting of infection, rising creatinine levels and low tacrolimus levels. Unfortunately, she developed a large infected hematoma of the transplanted kidney post-biopsy with secondary arterial hypertension. Her systolic blood pressure reached 200mmHg (Page phenomenon).
The patient went to theater for an open washout of the hematoma. Her blood pressure settled post-operatively and she went on to improve clinically.
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