Seventy renal transplant recipients with suspected urologic problems underwent interventional radiologic procedures for further diagnosis and treatment. We found that 28 patients did not have urologic complications. The other 42 patients demonstrated a total of 62 complications, including 40 cases of obstruction, 12 cases of extravasation, and ten collections of pararenal fluid. Ultrasound and nuclear renal scans with both technetium-99m DTPA and iodine-131 hippuran were found to be sensitive screening techniques for the detection of these complications. Fifty of the 51 abnormalities were detected using a combination of these techniques. Percutaneous methods alone were successful in treating 15 urinary obstructions, eight pararenal fluid collections, and five urinary extravasations. We encountered six procedure-related complications, and there were three delayed infectious complications that were related to indwelling nephrostomy tubes. One of these three complications resulted in death. The results of our study suggest that invasive radiologic procedures can be safely used to diagnose and treat urologic complications in renal transplant recipients.
Mammography is important in women who elect lumpectomy and radiation therapy for breast carcinoma: to record the preoperative state, to assess the completeness of resection, and to detect recurrences and second primaries. Mammography of these patients, however, is difficult since surgery and irradiation may cause changes simulating carcinoma. This article describes the findings in the postsurgical and irradiated breast and the difficulty of differentiating the changes from recurrent carcinoma. It also illustrates the findings in recurrences and second primaries.
Two cases of abdominal lymphatic disruption following surgery on the abdominal aorta are presented, one causing chylous ascites and the other resulting in a lymphocele. These complications have been only rarely described following abdominal vascular surgery. Both patients responded to percutaneous aspiration without recurrence. The radiologist has a major role in both the detection and management of this complication.
Eight lymphatic fluid collections were drained percutaneously. There were no immediate or late complications. Seven patients had follow-up; 1 required surgical drainage of a residual or recurrent lymphocele, and another had reaccumulated fluid in a lymphocele which was detected on autopsy. The remaining lymphatic collections responded to percutaneous drainage. Percutaneous drainage is safe and can be an effective tool in the management of lymphatic collections.
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