Genito-urinary Imaging
may result in a phantom calyx when that segment of the kidney becomes non-functional.4
parenchymal gross calcifications.
Renal tuberculosis may manifest as extensive cavitation (open or extensive forms) or fibrosclerosis (closed forms).9–11
The open
or extensive form (see Figure 3) corresponds to the extension of the caseified tissue necrosis to the intra-renal excretory tract. Parenchymal masses can develop, and may be calcified.4 Communication of the granulomas with the collecting system can lead to regional spread of 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
1. Engin G, Acunas B, Acunas G, Tunaci M, Imaging of extrapulmonary tuberculosis, Radiographics, 2000;20:471–88.
2. Harisinghani MG, McLoud TC, JO Shepard, et al., Tuberculosis from head to toe, Radiographics, 2000;20:449–70.
3. Gibson MS, Puckett ML, Shelly ME, Renal tuberculosis, Radiographics, 2004;24:251–6.
4. Kenney P, Imaging of chronic renal infections, AJR Am J Roentgenol, 1990;155:485–94.
5. Simon HB, Weinstein AJ, Pasternak MS, et al., Genitourinary tuberculosis: clinical features in a general hospital population, Am J Med, 1977;63:410–20.
CT is highly accurate at demonstrating
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 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).
with autonephrectomy. In the putty kidney, a calcified and thick material fills the dilated collecting system.13
n
6. Stacul F, Rossi A, Cova MA, CT urography: the end of IVU?, Radiol Med, 2008;113:658–69.
7. Chow LC, Kwan SW, Olcott EW, Sommer G, Split-bolus MDCT urography with synchronous nephrographic and excretory phase enhancement, AJR Am J Roentgenol, 2007;189:314–22.
8. Dillman JR, Caoili EM, Cohan RH, et al., Comparison of urinary tract distension and opacification using single-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.
13. Quaia E, Giarraputo L, Martingano P, Cavallaro M, Chronic Renal Infections and Renal Fungal Infections. In: Quaia E (ed.), Radiological Imaging of the kidney, Heidelberg-New York: Springer Verlag, 2010; 445–73.
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
60
US RADIOLOGY
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34 |
Page 35 |
Page 36 |
Page 37 |
Page 38 |
Page 39 |
Page 40 |
Page 41 |
Page 42 |
Page 43 |
Page 44 |
Page 45 |
Page 46 |
Page 47 |
Page 48 |
Page 49 |
Page 50 |
Page 51 |
Page 52 |
Page 53 |
Page 54 |
Page 55 |
Page 56 |
Page 57 |
Page 58 |
Page 59 |
Page 60 |
Page 61 |
Page 62 |
Page 63 |
Page 64 |
Page 65 |
Page 66 |
Page 67 |
Page 68