Urinary obstruction from lymphocele

Abstract

A 65-year-old, nondiabetic female with polycystic kidney disease received a dual kidney transplant. She had immediate graft function; however, the posttransplant course was complicated by recurrent urinary tract infections (UTIs). She was admitted 2 months after transplant for elevated creatinine (Cr) of 2.0 mg/dl. Renal ultrasound (US) showed patent allograft vasculature and no hydronephrosis; however, a small perinephric fluid collection and a larger collection around the urinary bladder were seen. Post-void residual was 150 ml. Computed tomography (CT) scan of pelvis revealed a horseshoe-shaped collection around the urinary bladder extending across the midline, causing extrinsic compression (Figures 1 and 2). Urine culture grew pseudomonas aeuroginosa, 10,000–100,000 CFU/ml. Renal dysfunction was attributed to UTI, secondary to urinary obstruction from extrinsic bladder compression. Fluid collection (320 ml) was drained under CT guidance. The fluid had a white blood cell count of 938/mm3 with differential showing 100% lymphocytes. A diagnosis of lymphocele was made. Following drainage, serum Cr downtrended to 1.5 mg/dl within 48 h with resolution of symptoms. The patient was discharged home on oral antibiotics. At the 3 month post-procedure follow-up, the patient was doing well without any new symptoms.