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"The seagull cry": a sign of emergency after renal transplantation?

Duplex ultrasound is widely used to detect vascular dysfunction after kidney transplantation. We describe musical murmurs found in renal allografts.

A 29-year-old man with an increase in serum creatinine 1 month after cadaveric kidney transplantation was referred for duplex ultrasound to exclude perfusion dysfunction. Renal arterial and venous circulation was normal. However, during Doppler spectral recording, a loud “seagull cry” was audible (audio file in the online-only Data Supplement). Spectral analysis displayed mirror-image parallel strings and bands of low to moderate frequency (Figure 1A and B). A small arteriovenous fistula, presumably after previous biopsy, was detected as cause of the turbulent flow. Inasmuch as no bleeding complication or pseudoaneurysm formation occurred, a conservative strategy was chosen, and follow-up with duplex ultrasound was recommended. 



Figure 1. A and B, Renal transplant with …