GUTB is the second most common form of extrapulmonary tuberculosis in developing countries, primarily affecting the kidneys through hematogenous spread. It is associated with infertility in women, with significant imaging findings including calcifications and ureter distortion due to strictures and necrosis. Diagnostic imaging such as CT and urography can reveal characteristic features, including the 'cobra head sign' and other pathologies in the urinary system.

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”.