Answer for BIR CoW 22 Sep 2024
Genitourinary Tuberculosis
Findings
IVU FINDINGS: Left IVU shows asymmetrical dilatation of calyces due to infundibular stenosis with blunting of the upper group of calyces. E/O few fuzzy and irregular calyceal margins of the lower group of calyces. -MOTH EATEN APPEARANCE. Multiple strictures noted in upper 1/3 rd of left ureter-BEADED APPEARANCE OF URETER. Stricture in distal left ureter with mild segmental dilatation. Bladder appears normal.
Discussion
The genitourinary region is one of the most common sites of extrapulmonary tuberculosis involvement. Renal TB is the most frequent form of genitourinary TB. Renal TB can be divided into that with renal parenchymal involvement and that with pelvicalyceal system involvement. Pelvicalyceal System: Earliest stages of disease usually manifests as papillary necrosis or minor calyceal deformity. IVU in the diagnosis of papillary necrosis, whereby excreted contrast material outlines the necrotic papilla, with various described appearances. These appearances include a)central excavation with a ball-on-tee appearance b)forniceal excavation c)lobster claw appearance d)signet ring appearance e)sloughed papilla with a clubbed calyx With progression of TB, the calyceal margins become fuzzy and irregular owing to erosion,resulting in the so-called “moth-eaten” calyx sign. Phantom calyx -Complete stricturing of an infundibulum causing failed contrast material excretion and nonvisualization of the involved calyx. Ureter: The distal third of the ureter, followed by the ureteropelvic junction,is the most common site of involvement. Scarring in the adjacent tissues due to chronic inflammation leads to a sharp kink at the ureteropelvic junction, also called the Kerr kink. Mucosal ulceration of the ureter causes ragged irregularity of the lumen with a dilated caliber, resulting in a sawtooth appearance Ureter may heal as a straight and rigid tube, referred to as a pipe stem ureter. Healing also results in scarring, with a so-called beaded or corkscrew ureter.
Findings
IVU FINDINGS: Left IVU shows asymmetrical dilatation of calyces due to infundibular stenosis with blunting of the upper group of calyces. E/O few fuzzy and irregular calyceal margins of the lower group of calyces. -MOTH EATEN APPEARANCE. Multiple strictures noted in upper 1/3 rd of left ureter-BEADED APPEARANCE OF URETER. Stricture in distal left ureter with mild segmental dilatation. Bladder appears normal.
Discussion
The genitourinary region is one of the most common sites of extrapulmonary tuberculosis involvement. Renal TB is the most frequent form of genitourinary TB. Renal TB can be divided into that with renal parenchymal involvement and that with pelvicalyceal system involvement. Pelvicalyceal System: Earliest stages of disease usually manifests as papillary necrosis or minor calyceal deformity. IVU in the diagnosis of papillary necrosis, whereby excreted contrast material outlines the necrotic papilla, with various described appearances. These appearances include a)central excavation with a ball-on-tee appearance b)forniceal excavation c)lobster claw appearance d)signet ring appearance e)sloughed papilla with a clubbed calyx With progression of TB, the calyceal margins become fuzzy and irregular owing to erosion,resulting in the so-called “moth-eaten” calyx sign. Phantom calyx -Complete stricturing of an infundibulum causing failed contrast material excretion and nonvisualization of the involved calyx. Ureter: The distal third of the ureter, followed by the ureteropelvic junction,is the most common site of involvement. Scarring in the adjacent tissues due to chronic inflammation leads to a sharp kink at the ureteropelvic junction, also called the Kerr kink. Mucosal ulceration of the ureter causes ragged irregularity of the lumen with a dilated caliber, resulting in a sawtooth appearance Ureter may heal as a straight and rigid tube, referred to as a pipe stem ureter. Healing also results in scarring, with a so-called beaded or corkscrew ureter.
Note:
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!
We do not discourage differential diagnosis. But all the differentials must satisfy the findings noted in the case.
If you feel you have answered rightly but cannot find your name in the above list, please call 09551942599.
Did you Know?
The order in which the names appear in this winner's list is based on the time of submission. The first person to send the correct answer gets his/her name on top of the list!