Multimodality imaging of a pancreatic transplant. A case report

A 41-year-old man who had insulin-dependent diabetes mellitus from the age of 14 underwent cadaveric renal transplant in 1984. Two years later, the patient underwent pancreatic allograft transplantation. The patient did well for eight days after the operation and did not require exogenous insulin. After the eighth day, serum glucose levels rose. Multiple radiologic studies were performed to assess the possibility of graft rejection. A Tc-99m DTPA study revealed a gradual decrease in perfusion, and an In-111 oxine WBC study showed nonspecific inflammation. CT scanning and MRI displayed postsurgical anatomical relationships and excluded a peripancreatic fluid collection, but were unable to demonstrate parenchymal abnormality of the pancreas. Tests for infection proved negative. Because the decreased blood flow demonstrated by DTPA study indicated transient ischemia, the patient was treated for graft rejection and stabilized quickly.