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Genitourinarytuberculosis 140524142841 Phpapp02
Genitourinarytuberculosis 140524142841 Phpapp02
ANNIE AGARWAL
23/02/2013
INTRODUCTION
young to middle-aged adults.
Uncommon in children
Causative organism :
Mycobacterium
Tuberculosis.
OTHER COMPLICATIONS:
Perinephric inflammation
Abscess formation :including psoas abscess
Fistulae
Sinus tract into adjacent tissues or viscera.
PATHOGENESIS
Progressive
involvement of renal
parenchyma
coalescence of
granulomas leading to Seen in advanced renal
unifocal or multifocal tuberculosis Autonephrectomy : end
mass lesions stage d/s
Focal or diffuse
Increase renal length involvement - fibrosis.
Increase thickness of Caseo –
renal substance cavernous type:
Parenchymal surface
Displacement of enlarged sac
scarring over retracted
collecting system. filled with
papillae or pelvis and
dilated/ deformed caseous
calyces. material, +/-
Erosion of pyramid calcification
Cortical / papillary
necrosis Associated calcification Calcified
Caliectasis or calculi shrunken non
Cavity Impaired excretion of functioning of
Deformed calyx contrast kidney
Following the drainage of a cavity into
the collecting system, there is spread of
infection to other parts of the urinary
tract.
neck of a calyx –
hydrocalyx, regional
hydrocalycosis
Calcification
IVU-
assess the extent and severity of involvement
To monitor response to treatment
To look for complications
Imaging findings :
Earliest abnormality –
On IVP :
Phantom calix
Infundibular stenosis
Phantom calyces
Ghost - like
RGP
beaded or
corkscrew
irregular segments of ureter
appearance.
due to mucosal ulcerations
necrosis of ureteral
musculature is accompanied Terminal
by fibrosis - stricture formation- segment of
50%. the ureter
Ulcerations causing
mucosal irregularity of
ureter.
Beaded / Corkscrew ureter
Fusion of multiple strictures
may create a long, irregular
narrowing. Several
nonconfluent strictures can
produce a “beaded” or
“corkscrew” ureter
Large tuberculomas in
Shrunken & calcification later vesical wall – manifest as
filling defects
Uses :MDCT:
Renal and extra renal spread of disease.
Length of ureteric stricture
Adjoining retroperitoneal disease
Associated spinal or solid organ involvement.
Bladder Tuberculosis
thickened bladder wall (= muscle
hypertrophy + inflammatory tuberculomas)
filling defects (due to multiple granulomas)
bladder wall ulcerations
shrunken bladder - scarred bladder with
diminished capacity - thimble bladder• .
bladder wall calcifications (rare)
CT urogram shows severe nonuniform caliectasis and multifocal strictures (arrowheads) involving renal
pelvis and ureter.. Calcification (arrow) is noted in left distal ureter.
A, Contrast-enhanced CT scan obtained at level of right renal hilum
shows wedge-shaped hypoperfused areas (arrowheads).
B, CT scan - hypoperfused areas (arrowheads) and focal caliectasis
(arrows)
(a) Contrast-enhanced excretory-phase CT scan shows dilated
calices and narrowing of the infundibula (arrowheads).
53-year-old man with tuberculosis involving collecting system. Contrast-
enhanced CT scan of left kidney shows uneven caliectasis caused by
varying degrees of stricture at various sites.
(a) Contrast-enhanced nephrographic-phase CT scan shows dilated
calices and thinning of the renal cortex (arrow). (b) Magnified view
from a contrast-enhanced nephrographic-phase CT scan obtained
caudad to a shows mural enhancement and thickening of the proximal
ureter (arrow).
Renal Tuberculosis. Coronal reformatted non-enhanced CT scan of the
abdomen and pelvis demonstrates a small, left kidney containing
globular calcifications (white circle) pathognomonic for renal tuberculosis.
The left kidney shows large,
dense, oval calcifications.
Low-density areas in the right
CT scan shows dense calcification kidney probably represent
replacing right kidney, so-called “putty foci of caseous necrosis.
kidney.” in NCCT
MRI
MR urography: evaluate poorly or non
functioning kidney specially obstructive
form for demonstration of ureteric
involvement.
Tuberculous epididymitis
○ ascending / descending route of infection
Tuberculous orchitis
○ direct extension from epididymal infection, rarely from
hematogenous spread
Prostatic involvement :
Plain radiographs-dense calcification within the prostatic bed
Cavities/ abscesses--discharge into the surrounding tissues sinuses or
fistulae to the perineum or rectum ‘ watering-can perineum.’
Cystourethrography-
○ early cases - filling of the prostatic ducts without evidence of
cavitation,
○ Advanced cases the ducts may be greatly dilated.
○ Varying degrees of destruction of prostatic parenchyma with
sloughing may produce irregular cavities.
Prostatic abscess,
T2-weighted MRI
shows a peripheral
enhancing cystic mass
with radiating, streaky
areas of low signal
intensity.
Female genital tract - TB
Hematogenous spread.
Associated wet or dry peritonitis
strongly associated with infertility in women,
rates of successful pregnancy remain low
even after treatment.
Scarring fallopian
tubes.
Scarring results in
a “T” shaped
uterine cavity with
intravasation of
contrast.
Appearance similar to Bilateral
tubal ligation. Elongation and
dilatation of cervical canal
Lymph node calcification
Bilateral cornual block &
intravastion of dye in vessels &
lymphatics.
Intravasation of dye into
myometriums and lymphatics and
left terminal hydrosalpingx
SUMMARY