- Genitourinary TB : Facts
- The GU tract is affected by TB in 15-20% of patients with extrapulmonary involvement
- The interval between initial pulmonary infection and the manifestations of genitourinary disease varies from 5 to 40 years
- Symptoms are often nonspecific with increased frequency, dysuria and hematuria
- 20% of patients with GU TB have a negative result at skin testing - Genitourinary TB : CT Findings
- Papillary necrosis
- Renal calcifications may be amorphous, granular, curvlinear or globular in appearance
- Fibrosis or stricture may occur
- Parenchymal scarring with non functioning kidney may occur ( “putty kidney”)
- Ureter or bladder involvement always seen with renal involvement - “ The diagnosis of renal tuberculosis should be considered when a patient has recurrent urinary tract infections that do not fully resolve after conventional antibiotic therapy and when fine urothelial calcifications and caliceal dilatation are seen at imaging.”
Genitourinary Tuberculosis
Wong A et al
RadioGraphics 2012; 32:839-844
- Pyelonephritis
- Mimics renal infarcts
- Mimics renal vein thrombosis
- Mimics obstruction with striated nephrogram
- Mimics lymphoma
- Acute Abdominal Pain
Siewert et al, AJR 1997;168:173-178
- 91 patients with acute abdomen
- CT compared with clinical evaluation
- CT was superior to clinical evaluation - Sensitivity: CT (90%), Clinical Eval (76%)
- CT changed management in 25/91 patients
- Acute Pyelonephritis: CT Findings
- Enlarged, swollen kidney
- Perinephric stranding
- Delay in contrast excretion
- Loss of corticomedullary differentiation
- Striated nephrogram: Striations result from stasis of contrast within edematous tubules that demonstrate increasing attenuation overtime
- Focal pyelonephritis can mimic a mass
- Erdheim-Chester Disease: Facts
- Renal and perirenal involvement in up to 29% of cases
- May encase the thoracic or abdominal aorta (looks like retroperitoneal fibrosis)
- Cardiac infiltration may be endocardial, myocardial or pericardial
- Erdheim-Chester Disease: Facts
- Rare form of non-Langerhans cell histiocytosis
- Characterized by tissue infiltration by foamy histiocytes
- Usually in patients over age 40
- Can be life threatening
- Perinephric Mass: Differential Dx
- Proliferative diseases
- Extramedullary hematopoiesis
- Retroperitoneal fibrosis
- Rosai-Dorfman disease
- Erdheim-Chester disease
- Perinephric Mass: Differential Dx
- Fluid
- Hematoma
- Urinoma
- Abscess
- Pancreatic pseudocyst
- Papillary Necrosis: Etiologies
- Diabetes
- Analgesic abuse
- Sickle cell disease
- Renal vein thrombosis
- Obstructive uropathy
- "The attenuation coefficient of a cystic renal lesion increased by no more than 10H among the unenhanced, corticomedullary, and parenchymal phase scans."
Analysis of Changes in Attenuation of Proven Renal Cysts on Different Scanning Phases of Triphasic MDCT
Chung EP et al.
AJR 2004; 182:405-410
- "This study shows that cystic lesions typically reveal a change in attenuation of less than 10HU between the scanning phases of a triphasic MDCT, affirming Bosniaks initial assertion that 10HU is a reasonable cutoff for determining enhancement in renal lesions."
- "This study shows that cystic lesions typically reveal a change in attenuation of less than 10HU between the scanning phases of a triphasic MDCT, affirming Bosniaks initial assertion that 10HU is a reasonable cutoff for determining enhancement in renal lesions."
Analysis of Changes in Attenuation of Proven Renal Cysts on Different Scanning Phases of Triphasic MDCT
Chung EP et al.
AJR 2004; 182:405-410
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