Imaging


the bacilli into the renal pelvis, ureters, urinary bladder and accessory genital organs. Extensive cavitation may determine renal caseation, whereas a fibrosing reaction of the urinary tract results in obstructive hydronephrosis. When the process spreads into the collecting system, there are three possible pathways for evolution of the disease: extensive cavitation (see Figure 3), fibrosclerosis with resulting non-communicating cavities, and recurrent ‘poussées.’


The closed or fibrosclerotic form (see Figure 4) responds better to therapy and consists of the extension of the caseified necrosis toward the renal parenchyma. The host’s healing response induces fibrosis with calcium deposition, focal fibrosis with progressive parenchymal scarring, stricture formation and dilatation of the intra-renal urinary tract and autonephrectomy (no functional contrast excretion). The fibrosclerotic forms of renal TB may appear as: pure fibrosclerosis with parenchymal scar (see Figure 4), often with evidence of non-communicating cavities (see Figure 4); or reactivation of the granulomatous process over a permanent status of fibrosclerosis with caseous necrosis and cavitation, or a mixed fibrosclerotic and cavitating form, resulting in communicating or non-communicating cavities with the intra-renal urinary tract. Both forms determine parenchymal calcifications and deformation of the


1. 2. 3. 4. 5.


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adjacent renal calyces, from simple narrowing of the calyx, to medullary and papillary necrosis, to obstructive hydronephrosis or hydrocalyx. Calcifications3


within the renal parenchyma are


common (occurring in 37–71% of cases) (see Figure 4) and follow a variety of patterns. Calcifications may be amorphous, granular, lobar or curvilinear, and frequently extend beyond the kidney (e.g. psoas muscle). The end-stage of renal tuberculosis corresponds to extensive renal parenchyma caseation and cavitation, resulting in the putty kidney (see Figure 5). The entire kidney becomes small, scarred and densely calcified,12


with autonephrectomy. In the


putty kidney, a calcified and thick material fills the dilated collecting system. n


Emilio Quaia is an Assistant Professor in the Department of Radiology at Cattinara Hospital at the University of Trieste in Italy. His principal interest is imaging of the abdomen, and he is the author of more than 100 publications in this field, including full papers and book chapters. He is a reviewer for several major radiology journals and a member of the Radiological Society of North America, Inc. (RSNA), the European Society of Radiology (ESR) and the European Society of Gastrointestinal Abdominal Imaging (ESGAR).


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bolus 3-Phase vs split-bolus 2-phase multidetector row CT urography, J Comput Assist Tomogr, 2007;31:750–7.


9. Becker JA, Renal tuberculosis, Urol Radiol, 1988;10:25–30. 10. Wang LJ, Wong YC, Chen CJ, CT features of genitourinary tuberculosis, J Comput Assist Tomogr, 1997;21:254–8.


11. Dalla Palma L, Pozzi Mucelli F, Imaging of chronic renal infections, Radiologe, 2000;40:537–46.


12. Goldman SM, Fishman EK, Hartman DS, et al., Computed tomography of renal tuberculosis and its pathological correlates, J Comput Assist Tomogr, 1985;9:771–6.


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