Answer for BIR CoW 12 May 2024
Genitourinary tuberculosis
Findings
Dilated and tortuous right ureter with beaded appearance and kinking of proximal ureter noted. Thickening of proximal and mid ureter noted Left kidney shows asymmetric caliectasis. Bladder appears small and thickened. Right distal ureteric stricture with hydroureteronephrosis noted.
Discussion
The genitourinary region is one of the most common sites of extrapulmonary tuberculosis (TB) involvement. The imaging features of genitourinary TB can mimic other entities, including malignancy, and pose a diagnostic dilemma. Hematogenous seeding and lymphatic spread of mycobacteria from pulmonary, tonsillar, and nodal TB are implicated in the pathogenesis of genitourinary TB.
The earliest parenchymal changes seen at imaging are tiny granulomas. Parenchymal granulomas are hypoattenuating, with minimal to no enhancement on contrast-enhanced CT images. These lesions can mimic renal cell carcinoma and often are confirmed to be TB granuloma at biopsy only; hence, the description of these lesions as demonstrating a pseudo tumoral pattern.
Complications include the formation of an abscess, which can rupture into the perirenal space. Pelvicalyceal involvement usually manifests as papillary necrosis.
Various described appearances in CT urography include:
1. Central excavation with a ball-on-tee appearance
2. Lobster claw appearance
3. Signet ring appearance
Calyceal blunting due to mucosal edema is usually considered the earliest sign of calyceal TB at IVU.
Imaging findings include:
- Acute adrenalitis
- Adrenal gland calcifications (diffuse and focal)
- Urothelial thickening
- “Moth-eaten” calyx
- Papillary necrosis
- Calyceal blunting
- Infundibular stenosis
- Pyelonephritis
- Cortical abscess rupturing into the perinephric space and into the collecting system
- Lobar calcification/putty kidney
- Autonephrectomy
- Cortical scarring
- Hiked-up pelvis (Kerr kink)
- Stricturing and beading of ureters
- Thimble bladder
- Urethral stricture
Findings
Dilated and tortuous right ureter with beaded appearance and kinking of proximal ureter noted. Thickening of proximal and mid ureter noted Left kidney shows asymmetric caliectasis. Bladder appears small and thickened. Right distal ureteric stricture with hydroureteronephrosis noted.
Discussion
The genitourinary region is one of the most common sites of extrapulmonary tuberculosis (TB) involvement. The imaging features of genitourinary TB can mimic other entities, including malignancy, and pose a diagnostic dilemma. Hematogenous seeding and lymphatic spread of mycobacteria from pulmonary, tonsillar, and nodal TB are implicated in the pathogenesis of genitourinary TB.
The earliest parenchymal changes seen at imaging are tiny granulomas. Parenchymal granulomas are hypoattenuating, with minimal to no enhancement on contrast-enhanced CT images. These lesions can mimic renal cell carcinoma and often are confirmed to be TB granuloma at biopsy only; hence, the description of these lesions as demonstrating a pseudo tumoral pattern.
Complications include the formation of an abscess, which can rupture into the perirenal space. Pelvicalyceal involvement usually manifests as papillary necrosis.
Various described appearances in CT urography include:
1. Central excavation with a ball-on-tee appearance
2. Lobster claw appearance
3. Signet ring appearance
Calyceal blunting due to mucosal edema is usually considered the earliest sign of calyceal TB at IVU.
Imaging findings include:
- Acute adrenalitis
- Adrenal gland calcifications (diffuse and focal)
- Urothelial thickening
- “Moth-eaten” calyx
- Papillary necrosis
- Calyceal blunting
- Infundibular stenosis
- Pyelonephritis
- Cortical abscess rupturing into the perinephric space and into the collecting system
- Lobar calcification/putty kidney
- Autonephrectomy
- Cortical scarring
- Hiked-up pelvis (Kerr kink)
- Stricturing and beading of ureters
- Thimble bladder
- Urethral stricture
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!