Imaging Findings of Urinary Tuberculosis on Excretory Urography and Computerized Tomography

Wang, Li J.; Wu, Ching-Feng; Wong, Yon-Cheong; Chuang, Cheng Keng; Chu, Sheng Hsien; Chen, Chi J.

doi:10.1016/s0022-5347(05)63947-x

Cited by 57 publications

(47 citation statements)

References 18 publications

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“…5,6 A CT scan may show calcifications, renal parenchymal masses, thick urinary tract walls and extraurinary TB manifestations. 11 CT is the most sensitive in detecting and characterizing renal calcifications. 12 Confirmation of GU TB can be made by demonstrating Mycobacterium tuberculosis in the urine.…”

Section: Discussionmentioning

confidence: 99%

Genitourinary tuberculosis masquerading as a ureteral calculus

Wong

Hoag

Jones

et al. 2013

CUAJ

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The genitourinary tract is a common extrapulmonary site of tuberculosis infection, yet remains a rare clinical entity in North America. We report the case of a 37-year-old man who presented for extracorporeal shock wave lithotripsy for a suspected ureteral stone on imaging. Further workup confirmed a diagnosis of genitourinary tuberculosis. Medical management was undertaken and, ultimately, nephrectomy performed. This case highlights the importance of maintaining a high index of clinical suspicion for genitourinary tuberculosis. Case reportWe report the case of an otherwise healthy 37-year-old male that was referred for extracorporeal shock wave lithotripsy (ESWL) of a presumed left ureteric stone. The patient reported a 2-month history of left flank pain and 5 months of intermittent hematuria. He also reported several months of feeling unwell with occasional fever. The patient was an immigrant from the Philippines, who works as a prison guard in Canada. Physical examination was unremarkable. A kidney, ureter, bladder (KUB) radiography pre-ESWL revealed a 5 × 4-mm oval calcified density within the left hemipelvis that was presumed to represent a ureteral calculus (Fig. 1). Based on history and imaging review, non-contrast and subsequently contrast-enhanced abdominal/pelvis computed tomography (CT) scan were obtained to further workup the etiology of the calcification. These studies demonstrated left hydroureteronephrosis, with renal parenchymal and calyceal calcifications, but no ureteric calculus (Fig. 2). There were innumerable septated cystic lesions throughout the left renal parenchyma that was suspicious for a chronic infection, such as genitourinary (GU) tuberculosis (TB).Urinalysis demonstrated hematuria with sterile pyuria. The patient underwent full evaluation for a working diagnosis of GU TB; chest X-ray was normal. Sputum acid-fast bacillus (AFB) tests were negative. Urine AFB and polymerase chain reaction (PCR) were positive for TB infection. The patient was subsequently medically treated with TB quadruple therapy: Isoniazid, rifampin, ethambutol and pyrazinamide. Urine culture demonstrated growth of Mycobacterium tuberculosis.Due to the presence of left-sided obstruction, cystoscopy was performed for attempted left ureteric stent insertion. Direct visualization revealed an erythematous and friable bladder mucosa with diffuse bleeding. The left ureteric orifice was unable to be visualized. A left percutaneous nephrostomy tube was placed. Antegrade nephrostogram demonstrated dilatation and distortion of the obstructed collecting system with pan-ureteral strictures (Fig. 3).Due to the extensive involvement of the kidney and ureter, reconstruction of the left-sided collecting system and ureter to alleviate the obstruction was not felt feasible upon consensus review. In the setting of a normal, functioning contralateral kidney on nuclear renogram, opinion favoured delayed laparoscopic nephrectomy. After several months of medical treatment and once the urine culture was negative for TB, the patien...

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Section: Discussionmentioning

confidence: 99%

Genitourinary tuberculosis masquerading as a ureteral calculus

Wong

Hoag

Jones

et al. 2013

CUAJ

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“…CECT has arguably replaced IVU as the imaging modality of choice for the diagnosis and evaluation of genitourinary tuberculosis. CT findings are not specific and must be correlated with the clinical features [5].…”

Section: Discussionmentioning

confidence: 99%

Renal Tuberculosis Presenting as Thigh Abscess

2012

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Tuberculosis is one of the major health problems in India. Genitourinary tuberculosis, 20 % of all extrapulmonary tuberculosis, is the most common extrapulmonary system to be affected by this disease. Kidney is the most common genitourinary organ to be affected. A 50-year-old female presented with renal tuberculosis presenting as right upper thigh abscess, an uncommon presentation managed effectively by anti-tubercular therapy (ATT) and nephroureterectomy.

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“…Voiding problems; back, flank, and suprapubic pain; hematuria; urinary frequency; and nocturia are other symptoms. The most common laboratory and imaging findings are pyuria, albuminuria, hematuria and hydroureter, hydronephrosis, renal calcification, and an increase in wall density of the urinary tract [16,17]. A tuberculin skin test supports the diagnosis of TB [3].…”

Section: Discussionmentioning

confidence: 99%

Genitourinary tuberculosis in a 54-year-old woman: diagnostic difficulty

et al. 2010

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AbstractGenitourinary tuberculosis (GUTB) is an extrapulmonary manifestation of tuberculosis seen in 1.2% of all cases of tuberculosis. The clinical case of a 54-year-old woman diagnosed with GUTB is presented. Cloudy urine, abdominal pain, and microscopic hematuria led us to investigate for Mycobacterium tuberculosis. Although cultures were negative, positive Ehrlich-Ziehl-Neelsen (EZN) staining and a positive polymerase chain reaction (PCR) revealed the diagnosis of M. tuberculosis complex (MTC), which was confirmed by treatment success. It has been shown that PCR is a reliable and rapid method for establishing or supporting the diagnosis of tuberculosis and can be used in a routine diagnostic algorithm when conventional methods fail to identify MTC.

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Imaging Findings of Urinary Tuberculosis on Excretory Urography and Computerized Tomography

Abstract: When the 3 imaging patterns are shown on IVP and CT, tubercular cultures or biopsies are suggested to make the definite diagnosis of urinary tuberculosis. Thus, treatment can be initiated as early as possible.

Cited by 57 publications

References 18 publications

Genitourinary tuberculosis masquerading as a ureteral calculus

Genitourinary tuberculosis masquerading as a ureteral calculus

Renal Tuberculosis Presenting as Thigh Abscess

Genitourinary tuberculosis in a 54-year-old woman: diagnostic difficulty

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