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Renal transplants are the most frequent visceral transplant, and because of the absence of nephrotoxicity and radiation, ultrasound is widely used to monitor grafts and assess for complications. Complications can be categorised as vascular, parenchymal, ureteric and perinephric collections, with many occurring at predictable times post transplant. Awareness of these pathologies and their features is vital for all radiologists to enable early intervention and prolong graft survival.

Two unusual complications of immunosuppression, Castleman's disease and Kaposi's sarcoma, occurring in a renal transplant recipient, are reported. Kaposi's sarcoma is a potentially curable condition in immunosuppressed patients if recognized and treated appropriately. In this patient, the pulmonary Kaposi's sarcoma was not diagnosed and this lead to the patient's death.

PURPOSE: To 1) correlate spinal MR features and modes of clinical presentation associated with symptomatic neurologic deterioration following longstanding spinal trauma; 2) correlate degree of neurologic deficit with spinal MR appearance in these patients; and 3) determine the relationship between new symptoms and ongoing cord compression. METHODS: Retrospective examination of MR images, and correlation with clinical data, in 94 consecutive patients. RESULTS: Sixty-seven patients presented with either an increase in degree of myelopathy or ascending neurologic level. Spinal cord atrophy (43%), syrinx (41%), and cord compression (24%) were found most frequently. Whereas in patients with complete motor and sensory deficit cord atrophy was the most frequent finding (52%), 75% of patients with useful motor function had normal spinal cords. There was a significant association (P less than .05) between cord compression and the MR findings of cord atrophy and myelomalacia, whereas a normal cord was over twice as frequent in patients without spinal cord compression. MR imaging led to an active change in management in 15% of patients, with improvement following surgery in all operated cases. CONCLUSION: Although syrinx is a frequent, and treatable cause of delayed neurologic deterioration, MR will frequently show other abnormalities such as ongoing cord compression. MR imaging should be performed urgently in all patients with new symptoms to enable early treatment to prevent irreversible loss of function.

This case demonstrates the potential pitfall of obtaining CT images in the axial plane alone, with a fracture parallel to the imaging plane mimicking vertebral body destruction and associated epidural mass mimicking neoplasm. Chan et al. have discussed the value of reformatted CT images in coronal and sagittal planes to define better transverse vertebral fractures. The case also demonstrates the potential danger of bypassing plain radiographs with the aim of facilitating a rapid diagnosis. Plain films, performed in this case only after CT myelography, clearly demonstrated a transverse pathological fracture in an ankylosed spine with no evidence of neoplastic destruction, enabling easy diagnosis of SEH on the CT appearance. The delayed onset of neurological deficit after fracture reinforces the importance of education of the patient with AS. This principally involves altering patients to the fragility of their spine and to the importance of avoiding spinal trauma. However, patients with known AS should be warned to seek medical advice after even minor spinal trauma with the aim of minimizing the incidence of delayed neurological complications such as occurred in this patient.