Focal Posttransplantation Lymphoproliferative Disorder at the Renal Allograft Hilum
R. Lopez-Ben1,
J. K. Smith1,
C. E. Kew, II2,
P. J. Kenney1,
B. A. Julian2 and
M. L. Robbin1
1
Department of Radiology, The University of Alabama Hospitals, The University
of Alabama at Birmingham, 619 19th St. South, Birmingham, AL 35294.
2
Department of Medicine, Division of Nephrology, The University of Alabama
Hospitals, The University of Alabama at Birmingham, Birmingham, AL
35294.
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Fig. 1A. —37-year-old man with decreasing renal function who was
referred for sonography to exclude hydronephrosis. After immunosuppression was
decreased in patient, mass became markedly smaller and renal function
improved. Longitudinal sonogram of renal transplant shows heterogeneous,
partly cystic mass (cursors) adjacent to renal hilum. Note dilatation
(arrow) of collecting system.
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Fig. 1B. —37-year-old man with decreasing renal function who was
referred for sonography to exclude hydronephrosis. After immunosuppression was
decreased in patient, mass became markedly smaller and renal function
improved. Longitudinal color Doppler sonogram of renal transplant shows main
renal artery (arrow) within hilar mass.
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Fig. 1C. —37-year-old man with decreasing renal function who was
referred for sonography to exclude hydronephrosis. After immunosuppression was
decreased in patient, mass became markedly smaller and renal function
improved. Longitudinal spectral Doppler sonogram of renal transplant shows
right iliac artery before anastomosis with peak systolic velocity of 0.91
m/sec. Corrected angle of insonation slightly exceeds 60°, which may lead
to overestimation of peak systolic velocity.
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Fig. 1D. —37-year-old man with decreasing renal function who was
referred for sonography to exclude hydronephrosis. After immunosuppression was
decreased in patient, mass became markedly smaller and renal function
improved. Longitudinal spectral Doppler sonogram of renal transplant shows
main renal artery (MRA) with peak systolic velocity of 3.10 m/sec. This
threefold increase in peak systolic velocity correlates with stenosis in our
sonography laboratory.
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Fig. 1E. —37-year-old man with decreasing renal function who was
referred for sonography to exclude hydronephrosis. After immunosuppression was
decreased in patient, mass became markedly smaller and renal function
improved. Coronal T1-weighted spin-echo MR image (TR/TE, 500/25) shows
intimate relationship of mass (arrow) to renal allograft and
resultant hydronephrosis. Note isointensity of T1 signal of in relation to
with renal allograft parenchyma.
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Fig. 2A. —49-year-old man with increased serum creatinine level 3
months after transplantation. Subsequent allograft nephrectomy histologically
confirmed mass as posttransplantation lymphoproliferative disorder.
Longitudinal sonogram shows 4.5 x 3.6 cm heterogeneous mass
(cursors) adjacent to renal allograft hilum.
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Fig. 2B. —49-year-old man with increased serum creatinine level 3
months after transplantation. Subsequent allograft nephrectomy histologically
confirmed mass as posttransplantation lymphoproliferative disorder. Color
Doppler sonogram shows small branching feeder vessels from main renal artery
into mass. These small vessels had arterial-type pulsatile waveform on
spectral Doppler interrogation.
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Fig. 2C. —49-year-old man with increased serum creatinine level 3
months after transplantation. Subsequent allograft nephrectomy histologically
confirmed mass as posttransplantation lymphoproliferative disorder.
Contrast-enhanced CT scan shows central low attenuation within heterogeneous,
mildly enhancing mass (arrows).
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Fig. 3A. —37-year-old woman with doubling of serum creatinine level to
2.4 mg/dL 7 months after transplantation. Subsequent allograft nephrectomy
confirmed small pararenal mass as posttransplantation lymphoproliferative
disorder. Transverse sonogram shows small hypoechoic mass (cursors)
near renal allograft. Although unusual, increased through transmission can be
seen in solid masses. Echogenicity was not characteristic of simple
lymphocele, and at 7 months after transplantation, hematoma is unlikely.
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Fig. 3B. —37-year-old woman with doubling of serum creatinine level to
2.4 mg/dL 7 months after transplantation. Subsequent allograft nephrectomy
confirmed small pararenal mass as posttransplantation lymphoproliferative
disorder. Axial fast spin-echo T2-weighted MR image (TR/TE, 5000/85) shows
well-marginated solid mass (arrow). Although some slightly higher T2
signal centrally can be seen, note mass is predominantly of lower signal
intensity than renal parenchyma.
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Fig. 4A. —20-year-old woman with decreased renal function 14 months
after transplantation. Allograft nephrectomy confirmed posttransplantation
lymphoproliferative disorder. Axial fast multiplanar spoiled gradient-echo
T1-weighted MR image (TR/TE, 140/4.2; flip angle, 70°) shows predominantly
low-signal mass (arrow).
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Fig. 4B. —20-year-old woman with decreased renal function 14 months
after transplantation. Allograft nephrectomy confirmed posttransplantation
lymphoproliferative disorder. MR image acquired after administration of
gadolinium with same sequence as that in A shows slight enhancement,
predominantly in periphery (arrow).
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Fig. 5A. —50-year-old woman with fever and decreasing renal function 6
months after transplantation. Allograft nephrectomy confirmed
posttransplantation lymphoproliferative disorder. Longitudinal sonogram shows
5 x 4 cm complex mass (cursors) slightly separate from renal
allograft hilum (arrow).
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Fig. 5B. —50-year-old woman with fever and decreasing renal function 6
months after transplantation. Allograft nephrectomy confirmed
posttransplantation lymphoproliferative disorder. Longitudinal color Doppler
sonogram shows mass encircling main and accessory renal artery as they arise
from external iliac artery (IL). M = mass.
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Fig. 5C. —50-year-old woman with fever and decreasing renal function 6
months after transplantation. Allograft nephrectomy confirmed
posttransplantation lymphoproliferative disorder. Unenhanced CT scan shows
mass (arrow) adjacent to inferior aspect of allograft. Note metallic
streak artifacts from vascular anastomosis surgical clips.
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Fig. 6A. —45-year-old woman with history of episode of rejection
presenting with decreasing renal function. Allograft nephrectomy confirmed
posttransplantation lymphoproliferative disorder. Longitudinal sonogram shows
heterogeneous hilar mass (cursors). Note hydronephrosis.
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Fig. 6B. —45-year-old woman with history of episode of rejection
presenting with decreasing renal function. Allograft nephrectomy confirmed
posttransplantation lymphoproliferative disorder. Percutaneous nephrostogram
shows mass effect on ureter (arrow) with medial displacement and mild
narrowing.
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