Background Renal allograft dysfunction monitoring is mainly performed using the serum creatinine (SC) level, Doppler ultrasound (US), or renal biopsy. Recently proposed diffusion-based magnetic resonance imaging (MRI) methods have been explored as new, non-invasive tools for assessing renal function after transplantation. Purpose To investigate the value of fractional anisotropy (FA) measurements in the evaluation of acute rejection cases after renal transplant. Material and Methods Doppler US and MRI diffusion tensor imaging (DTI) were performed in 21 patients with graft dysfunction requiring graft biopsy after renal transplantation and in 21 patients with normal graft function. The MR examinations were performed on a 1.5-T MRI using two b-values (0 and 800 s/mm). FA values were measured from the cortex and medulla of the transplanted kidney at the upper, middle, and lower poles. Results Twenty-one transplant patients diagnosed with acute rejection (Group 1) were compared to the control group of 21 transplant patients with normal graft function (Group 2). The measured FA values of the medulla were 0.19 ± 0.02 and 0.22 ± 0.05 ( P = 0.017) for Groups 1 and 2, respectively. On the other hand, the measured FA values of the renal cortex were 0.18 ± 0.04 and 0.18 ± 0.04 ( P = 0.97) for Groups 1 and 2, respectively. Conclusion The good correlation between the renal medulla FA values and allograft function shows that MR DTI has potential for non-invasive functional assessment of transplanted kidneys. On the other hand, the renal cortex FA values had no correlation with the allograft function.
Renal angiomyolipomas are rare benign lesions of the kidney with an incidence between 0.1% and 0.22% (1). They are composed of abnormal vasculature, smooth muscle, and adipose tissue. They are more likely to be symptomatic if they are larger than 4 cm, and present a history of flank pain, a palpable mass, and rarely haematuria. Also, they are most frequent etiology of Wunderlich syndrome, which is an emergency medical condition that refers to spontaneous nontraumatic bleeding confined to the perinephric space (2). Although benign, their rich neovascularization has a tendency for spontaneous rupture with consequent hemorrhage, which in some cases can be life threatening. Significant perinephric hemorrhage may occur in approximately 10% of patients with angiomyolipoma (3). This complication is related to the size of the tumor, the grade of the angiogenic component of the tumor, and the presence of tuberous. Herein, we present a catastrophic case of Wunderlich syndrome whose vital signs abruptly worsened, went into hypovolemic shock and required an urgent surgical approach.
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