Not All Leg Swelling Is Volume Overload: Point‐of‐Care Ultrasound and Sirolimus‐Associated Lymphedema After Combined Heart‐Kidney Transplant
Abstract
A 65-year-old man, one year post combined heart-kidney transplant, presented with acute kidney injury, dyspnea, and progressive leg edema unresponsive to escalating diuretics. Despite suspicion for volume overload, multi-organ point-of-care ultrasound (POCUS) revealed bilateral A-lines without B-lines or effusions, a small collapsible inferior vena cava, and preserved biventricular function, all inconsistent with cardiogenic congestion. The edema was attributed to sirolimus-associated lymphedema. Diuretic cessation and transition from sirolimus to everolimus improved renal function. This case illustrates the utility of integrated multi-organ POCUS in challenging assumptions about volume status and underscores the importance of contextualizing findings across multiple sonographic windows.
Fields of Study & Subjects
Transplantation: Methods and Outcomes
Renal and Vascular Pathologies
Renal Transplantation Outcomes and Treatments
Publication details
- Journal / source
- Clinical Case Reports
- Publisher
- Wiley
- Volume
- 14
- Issue
- 5
- Pages
- e72717–e72717
- Publication date
- 1 May 2026
- Language
- EN