Genitourinary Tuberculosis
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Genitourinary Tuberculosis

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Genitourinary Tuberculosis Genitourinary Tuberculosis Presentation Transcript

  • Dr. Chandrashekhar / Dr. Sudha K Das,Resident / Asst Professor,Radiology, JSSMC - Mysore
  •  Second most common form of extrapulmonary tuberculosis after lymph node tuberculosis in developing countries. The kidneys are the most common site of GUTB and are infected through hematogenous spread; from the kidneys, the bacilli can spread to the renal tract, prostate and epididymis. CT and intravenous urography can aid diagnosis— calcification, multiple strictures and fibrosis are suggestive features on imaging. GUTB is strongly associated with infertility in women, as the Fallopian tubes are affected in most cases, and rates of successful pregnancy remain low even after treatment.
  •  Following primary pulmonary infection, mycobacteria spread to the renal tract hematogenously. Caseating granulomata can form, which are usually bilateral and cortical. These granulomata can erode into the calyceal system resulting in disease spread to Postmortem Specimen Caseation in the Renal the rest of the renal tract. Cortices of a GUTB patient.
  • Irregular calix Fuzzy irregular calices, truncated calix, phantom calix – features of papillary necrosis. Necrosed papilla on USG
  • Fuzzy & irregular calices due to papillary necrosis.Normal calices
  •  Papillary (forniceal) excavation. The necrotic papillary tip may remain within the excavated calix, producing a signet ring sign when the calix is filled with contrast material.
  • Phantom calixInfundibular stenosis
  • Ghost - like RGPDecreased nephrographic opacity and nonfilling of the collectingsystem elements at the lower pole of left kidney – phantom calices(ghost : exist, but not visualised, the same are visualized on RGP).
  • On IVP :Collecting system shows contrastmaterial in a large papillary cavity, the―golf ball‖ (∗).Blunted calyx, the ―tee,‖ is adjacent(arrow).
  • => pulled upCephalic retraction of the inferiormedial margin of the renal pelvis at theureteropelvic junction (UPJ)
  •  Cortical scarring with dilatation & distortion of adjoining calices coupled with strictures of the pelvicaliceal system. Cause luminal narrowing either directly or by causing kinking of the renal pelvis at the UPJ.
  •  Ulcerations causing mucosal irregularity of ureter.
  •  Mucosal irregularity and erosions resulting in chronic fibrotic strictures of ureter. Mucosal thickening of ureter
  • Old pipe stem  Rigid ureter: irregular and lacks normal peristaltic movement, fibrotic strictures noted.  Note the distortion, amputation and irregularity of the upper pole calices.Pipe stem: for tobacco smoking, recent ones look like this..
  •  IVP: cobra head sign, the lucent halo is however thick, irregular and less well defined.  DD’s: calculus / tumor.Rao A, Yvette K, Chacko N. Tuberculosis of urinary bladder presenting aspseudoureterocele. Indian J Med Sci 2005;59:272-3
  •  Diminutive and irregular urinary bladder – simulating a thimble.
  •  Autonephrectomy. Diffuse, uniform, extens ive parenchymal calcifications forming a cast of the kidney with autonephrectomy. End stage of GuTB.
  •  HSG may demonstrate a flask-shaped dilatation of the fallopian tubes due to obstruction at the fimbria.
  •  Focal irregularity and areas of calcification occur within the lumen of the fallopian tubes.
  •  Caseous ulceration of the mucosa of the fallopian tube produces an irregular contour of the lumen of the tubes. Diverticular cavities may surround the ampulla and give a ―tuft‖ like appearance.
  •  Scarring fallopian tubes. Irregular and rigid.
  •  Multiple constrictions along the course of fallopian tube on HSG due to fibrotic strictures.
  •  Scarring results in a ―T‖ shaped uterine cavity.
  •  Prostatic abscess, T2-weighted MRI shows a peripheral enhancing cystic mass with radiating, streaky areas of low signal intensity.
  • Do mail us back at (jssmcrad@gmail.com) - if you come across more signs thatcan be added to this “sign soup”.