Approximately 3 weeks after deceased donor kidney transplantation, a patient developed oliguric renal failure. Renal sonogram demonstrated moderate hydronephrosis of the renal allograft secondary to compression of the transplanted ureter by a large fluid collection in the pelvis (Figure 1, top panel). CT scan confirmed the same (Figure 2) and the patient underwent ultrasound-guided drainage of ~450 cc fluid the next day with drain placement leading to improvement in urine output. Laboratory analysis of the fluid was consistent with lymphocele and repeat sonogram showed significant improvement (Figure 1, bottom panel).

Lymphocele is a lymphocyte-rich fluid collection that results from disruption of lymphatics in the recipient during renal transplantation. While small collections resolve spontaneously, larger, symptomatic ones may cause obstructive nephropathy requiring percutaneous or laparoscopic drainage. Prompt diagnosis obviates the need for renal replacement therapy.