Diagnostic Radiology

Plain Films

A preoperative chest film is always done to exclude significant pulmonary disease that may be a contraindication to proceeding with transplantation.

In the postoperative period, evaluation of the abdomen and chest with plain radiographs is done to exclude pleural effusions, pneumonia, pulmonary edema and intraabdominal free air. Bowel perforations may show few overt clinical signs, and careful evaluation of abdominal plain films may provide the first evidence of unusual air or fluid collections that may indicate intestinal or biliary anastomotic dehiscences.

Ultrasound

The single most useful radiological test in pediatric liver transplantation is the abdominal ultrasound.

Posttransplant day 1 ultrasound is essential for determining the early patency of all vascular anastomoses. The quality of ultrasound studies has improved dramatically over the last several years and obviates the need for angiograms in most cases to confirm arterial or portal venous occlusion. Doppler studies now can provide information about the velocity of flow in vessels as well as the resistive index in the hepatic artery. This information, while not always helpful, may provide the basis for future advances in the evaluation of vascular anastomoses.

Ultrasound also provides information regarding the presence of fluid collections. It may serve as the definitive study to determine the size and nature of a fluid collection, but CT scanning usually is more helpful in determining the need for further interventions or treatment.

Computerized Tomography

CT scanning gives a wealth of information on the anatomic state of the liver. Periportal edema is a common finding after transplantation and can persist for weeks. Fluid between the left lobe and the stomach or behind the cut surface of the liver is also common and does not necessarily signify infection.

CT scanning is the most definitive study in the investigation of fever. Fluid collections detected by ultrasound can be studied in greater detail with CT. Liver parenchymal lesions are seen in great detail on CT, including perfusion defects, intrahepatic fluid collections and bile duct dilatation.

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