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Genitourinary Tuberculosis

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

Publicado en: Salud y medicina
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Genitourinary Tuberculosis

  1. 1. Dr. Sudha Kiran Das, Asst Professor, Radiology, JSSMC - Mysore
  2. 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. 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.
  4. 4. Irregular calix  Fuzzy irregular calices, truncated calix, phantom calix – features of papillary necrosis. Necrosed papilla on USG
  5. 5. Fuzzy & irregular calices due to papillary necrosis. Normal calices
  6. 6.  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.
  7. 7. Phantom calix Infundibular stenosis
  8. 8. 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).
  9. 9. On IVP : Collecting system shows contrast material in a large papillary cavity, the “golf ball” (∗). Blunted calyx, the “tee,” is adjacent (arrow).
  10. 10. => pulled up Cephalic retraction of the inferior medial margin of the renal pelvis at the ureteropelvic junction (UPJ)
  11. 11.  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.
  12. 12.  Ulcerations causing mucosal irregularity of ureter.
  13. 13.  Mucosal irregularity and erosions resulting in chronic fibrotic strictures of ureter. Mucosal thickening of ureter
  14. 14.  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
  15. 15.  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
  16. 16.  Diminutive and irregular urinary bladder – simulating a thimble.
  17. 17.  Autonephrectomy.  Diffuse, uniform, extensive parenchymal calcifications forming a cast of the kidney with autonephrectomy.  End stage of GuTB.
  18. 18.  HSG may demonstrate a flask-shaped dilatation of the fallopian tubes due to obstruction at the fimbria.
  19. 19.  Focal irregularity and areas of calcification occur within the lumen of the fallopian tubes.
  20. 20.  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.
  21. 21.  Scarring fallopian tubes.  Irregular and rigid.
  22. 22.  Multiple constrictions along the course of fallopian tube on HSG due to fibrotic strictures.
  23. 23.  Scarring results in a “T” shaped uterine cavity.
  24. 24.  Prostatic abscess, T2-weighted MRI shows a peripheral enhancing cystic mass with radiating, streaky areas of low signal intensity.
  25. 25. Do mail us back at ( - if you come across more signs that can be added to this “sign soup”.