Clinical Presentation

A 53-year-old woman with diabetes mellitus and end-stage renal disease presents with rising serum creatinine 2 months after receiving a cadaveric renal transplant. (A living related donor transplant had failed 8 years previously.) The postoperative course was complicated by febrile neutropenia. Multiple biopsies of the transplant kidney showed moderate-severe acute tubular necrosis but no evidence of rejection. Multiple CT examinations of the pelvis showed a stable 8.1 × 3.4-cm accumulation of fluid adjacent to the transplant kidney.

Fig. 113.1

Fig. 113.2

Fig. 113.3

Technique

• ^99mTc-MAG-3 (5-10mCi) is the radiopharmaceutical of choice because of its higher extraction fraction, although ^99mTc-DTPA (10-20mCi) is an acceptable substitute.

• Dynamic imaging of the pelvis for 20 or 30 minutes is followed by 10-minute static views, repeated as necessary for up to 2 hours.

• For transplants located in the pelvis, imaging should be performed in the anterior view to avoid attenuation from the sacrum and pelvic bones.

• When possible, correlation should be made with anatomic imaging (CT, MRI, or ultrasound) to evaluate any grossly evident fluid collections.