Second most common form of extrapulmonary tuberculosis after lymph node tuberculosis in developing countries.

1. Dr. Sudha Kiran Das,
Asst Professor,
Radiology, JSSMC - Mysore

2.  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.

3.  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
the rest of the renal tract.
Postmortem Specimen
Caseation in the Renal
Cortices of a GUTB
patient.

5. Irregular calix
 Fuzzy irregular calices,
truncated calix,
phantom calix –
features of papillary
necrosis.
Necrosed papilla on USG

6. Fuzzy & irregular calices due to
papillary necrosis.
Normal calices

9.  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.

10. Phantom calix
Infundibular stenosis

11. Ghost - like
RGP
Decreased nephrographic opacity and nonfilling of the collecting
system elements at the lower pole of left kidney – phantom calices
(ghost : exist, but not visualised, the same are visualized on RGP).

12. On IVP :
Collecting system shows contrast
material in a large papillary cavity, the
“golf ball” (∗).
Blunted calyx, the “tee,” is adjacent
(arrow).

13. => pulled up
Cephalic retraction of the inferior
medial margin of the renal pelvis at the
ureteropelvic junction (UPJ)

14.  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.

15.  Ulcerations causing
mucosal irregularity
of ureter.

16.  Mucosal irregularity and
erosions resulting in
chronic fibrotic strictures
of ureter.
Mucosal thickening of ureter

17.  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..
Old pipe stem

18.  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 as
pseudoureterocele. Indian J Med Sci 2005;59:272-3

19.  Diminutive and
irregular urinary
bladder – simulating a
thimble.

20.  Autonephrectomy.
 Diffuse, uniform,
extensive parenchymal
calcifications forming a
cast of the kidney with
autonephrectomy.
 End stage of GuTB.

22.  HSG may demonstrate
a flask-shaped
dilatation of the
fallopian tubes due to
obstruction at the
fimbria.

23.  Focal irregularity and
areas of calcification
occur within the lumen
of the fallopian tubes.

24.  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.

25.  Scarring fallopian
tubes.
 Irregular and
rigid.

26.  Multiple constrictions
along the course of
fallopian tube on
HSG due to fibrotic
strictures.

27.  Scarring results in
a “T” shaped
uterine cavity.

28.  Prostatic abscess,
T2-weighted MRI shows
a peripheral enhancing
cystic mass with
radiating, streaky areas
of low signal
intensity.

29. Do mail us back at (jssmcrad@gmail.com) - if you come across more signs that
can be added to this “sign soup”.