title: Sonographic Evaluation of Clinically Significant Perigraft Hematomas in Kidney Transplant Recipients.
abstract: OBJECTIVE
  The purpose of this study was to assess the sensitivity of ultrasound in evaluating peritransplant hematomas that require surgical evacuation in recipients of kidney transplants.
  
  
  METHODS
  Thirty-four patients who underwent 37 hematoma evacuations underwent ultrasound examinations in the 24 hours before surgical evacuation. The operative reports were evaluated for presence and size of collection, presence of active bleeding at operation, and composition of the hematoma. The clinical findings leading to the ultrasound examination were recorded. Ultrasound examinations were evaluated in consensus by two board-certified and fellowship-trained abdominal radiologists for the presence, size, and echogenicity of the collection; subjective perfusion visualized with color and power Doppler ultrasound; velocities of the renal arteries; and arcuate artery resistive indexes.
  
  
  RESULTS
  Ten of the 37 imaged hematomas (27%) had either no or small (< 50 mL) fluid collections on ultrasound examination. With sonographic volumetry, the reported intraoperative volumes were underestimated by 46%. The mean arcuate artery resistive index was 0.82 in the superior pole, 0.81 in the mid pole, and 0.78 in the inferior pole of the kidney. A decrease in hemoglobin level was the most sensitive clinical finding for determining the presence of perigraft hematomas.
  
  
  CONCLUSIONS
  Our results suggest that gray-scale sonography alone appears to have limited sensitivity in detecting clinically significant peritransplant hematomas and that its use may result in overall underestimates of hematomas.
authors.affiliation: 1 Department of Radiology, University of California, Davis, Medical Center, 4860 Y St, Ste 3100, Sacramento, CA 95817. fananapazir@ucdavis.edu
authors.forename: Ghaneh
authors.initials: G
authors.lastname: Fananapazir
authors.affiliation: 1 Department of Radiology, University of California, Davis, Medical Center, 4860 Y St, Ste 3100, Sacramento, CA 95817.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Rao
authors.affiliation: 1 Department of Radiology, University of California, Davis, Medical Center, 4860 Y St, Ste 3100, Sacramento, CA 95817.
authors.forename: Michael T
authors.initials: MT
authors.lastname: Corwin
authors.affiliation: 1 Department of Radiology, University of California, Davis, Medical Center, 4860 Y St, Ste 3100, Sacramento, CA 95817.
authors.forename: Sima
authors.initials: S
authors.lastname: Naderi
authors.affiliation: 2 Department of Surgery, University of California, Davis, Medical Center, Sacramento, CA.
authors.forename: Chandrasekar
authors.initials: C
authors.lastname: Santhanakrishnan
authors.affiliation: 2 Department of Surgery, University of California, Davis, Medical Center, Sacramento, CA.
authors.forename: Christoph
authors.initials: C
authors.lastname: Troppmann
mesh_terms: D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity; D005260:Female; D006406:Hematoma / Q000000981:diagnostic imaging* / Q000601:surgery; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000601:surgery; D012079:Renal Circulation; D012680:Sensitivity and Specificity; D018615:Ultrasonography, Doppler, Color; D014655:Vascular Resistance
keywords: hematoma; renal transplant; sonography; ultrasound