Tuberculosis can affect any organ system in the body and can be devastating if left untreated.
In this poster we discuss and illustrate the common imaging features of tuberculosis affecting genitourinary system.
The aim of this work is:
1- To recognise morphologic changes in genitourinary tract in different imaging techniques which make tuberculosis (TB) a possibility of diagnosis even when it is not suspected previously by clinicians.
It can affect:
*Kidneys, 75% unilateral,
(calcifications,
moth-eaten calyx -due to erosion which progress to papillary necrosis-,
infundibular stenosis cortical scarring with dilatation and distortion of adjoining calices,
and strictures of the pelvicaliceal system producing luminal narrowing either directly or by causing kinking of the renal pelvis,
hydronephrosis tends to have irregular margins and filling defects owing to caseous debris,
calcifications in a lobar distribution in end-stage tuberculosis )
*Ureter, involvemente is more common in the distal third of the ureter (filling defects due to mucosal granulomas ,
strate thickening of the ureteral wall and peri-ureteral inflammatory changes,
chronic fibrotic strictures- specially in pelviureteric junction,
across the pelvic brim,
and at the vesicoureteric junction- and wall calcifications)
*Bladder ( reduced bladder capacity,
filling defects due to multiple granulomas,
calcified bladder )
*Genitalia ( endometrial adhesions,
obstruction of the fallopian tubes with multiple areas of constriction,
calcified lymph nodes in the adnexal region,
epididymo orchitis with focal or diffuse areas of decreased echogenicity with epididymal involvement )
2- To keep TB specially in mind when evaluating patients treated with intra vesical BCG ( Bacillus Calmette-Guerin).
Intravesical instillation of bacille Calmette-Guérin (BCG) effectively treats transitional cell carcinoma of the bladder.
Occasionally,
BCG infection complicates such treatment.
Local side effects of BCG installation therapy are defined as effects confined to the bladder or those organs that are in contact with BCG bacilli and those are the ones we are going to talk about in this poster .They are drug induced or chemical cystitis,
minor and major hematuria,
bladder contracture,
granulomatous prostatitis,
epididymo-orchitis,
ureteral obstruction and renal abscess.
Granulomatous prostatitis,
epididymo-orchitis,
ureteral obstruction and renal abscess can be considered as complication resulting from BCG contaminated urine.
Postponement of instillation and antituberculous antibiotics are necessary.
But there are also accepted BCG-related systemic complications like fever,
influenza-like symtoms,
pneumonitis,
hepatitis,
arthralgia and arthritis ,
citopenia and sepsis, that probably represents the immune response to BCG.
These symtoms usually resolve spontaneously,
being antipyretic drugs helpful,
but antituberculous drugs are not necessary unless in case of progressive systemic affection (including granulomatous pneumonitis or hepatitis).
In some patients,
infection appears early and in others it is a late presentation disease.
Noncaseating granulomas are found in the majority of cases,
whether early or late.