LEAK INTO THE PERITONEOUM

            Male 40 year old,  underwent bank  kidney transplantation. Renogram performed with 99m Tc-MAG-3. Kidney in right inferior abdominal quadrant with increased size and excellent perfusion (left and middle frames, red arrows). At right, the kidney has cleared, the bladder has significant contrast (yellow arrows). In addition, irregular peritoneal uptake is depicted (3 black arrows).

            This pattern is suggestive of a leak from the excretory system into the abdomen (1). Urinary extravasation occurs in less than 5% of kidney transplants and usually takes place a week or more after surgery. Sequential images show diffuse activity in the abdomen in the delay phase. Ultrasound is nonspecific in the differential diagnosis of fluid collections (urinomas, lymphoceles, hematomas, abscesses).

References:

1   Etchebere, Elba, Ramos Celso Dario y Camargo, Edwaldo. Trasplante Renal. p: 425-433 en: Medicina Nuclear Aplicaciones Clínicas. Eds: I. Carrio - P. González. Editorial Masson, Barcelona España, 2003.

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