Tuberculoma lesions most commonly form in the upper pole of the kidney and enlarge, rupturing into neighboring calyces and discharging caseous material. This distorts the calyx, causing irregularities on papillae surfaces. Early signs include a "moth-eaten" appearance to the calyx. Irregular tracts then form from the calyx to papilla. Large irregular cavities with extensive destruction can result from papillary necrosis. Cavitation within the renal parenchyma may appear as irregular pools of contrast material on imaging.