Diagnostic Ultrasound - Abdomen and Pelvis

Tuberculosis, Urinary Tract
Diagnoses: Urinary Tract
TERMINOLOGY
• Urinary tract infection (UTI) by mycobacterium tuberculosis
via hematogenous spread from primary focus, usually lungs
IMAGING
• Depends on stage of disease; may range from caliectasis,
abscess, cavities, calcifications, and strictures in urinary tract
• Early stage: Normal kidney or small focal cortical lesions
with poorly defined border ± calcification
• Progressive stage: Papillary destruction with echogenic
masses near calyces
• Mural thickening ± ureteric and bladder involvement,
associated stricture → hydronephrosis
• Small, fibrotic, thick-walled bladder
• Small, shrunken kidney, "paper-thin" cortex and dystrophic
calcification in collecting system
• CECT with CT urogram (CTU) is useful in diagnosing and
assessing severity
KEY FACTS
• Heavily calcified caseous mass surrounded by thin
parenchymal shell → "putty kidney"
• Hydrocalyces or "phantom calyx" (nonopacification of calyx
due to infiltration and obliteration) proximal to infundibular
stricture
• Late stages: Small, poor-functioning, scarred kidneys with
dystrophic calcification
• CT (CTU) has replaced IVP for diagnosis and to rule out
complications (strictures, abscess) and extrarenal
manifestation
• Ultrasound useful in assessing complications (renal abscess,
hydronephrosis)
TOP DIFFERENTIAL DIAGNOSES
• Papillary necrosis
• Pyonephrosis
• Xanthogranulomatous pyelonephritis (XGP)
• Cystitis
(Left) Longitudinal
transabdominal Color Doppler
ultrasound shows renal TB
with mild hydronephrosis
and avascular internal
echogenic debris ſt. (Courtesy
A. Pandya, MD.) (Right)
Longitudinal transabdominal
ultrasound shows renal TB
with distorted renal
parenchyma. There are small,
irregular, hypoechoic lesions
st, which represent cavities
connecting to the collecting
system.
(Left) Longitudinal
transabdominal ultrasound
shows renal TB with a large
cavity in the upper renal pole
ſt containing gas st
consistent with abscess.
(Courtesy A. Pandya, MD.)
(Right) Longitudinal
transabdominal ultrasound
shows a large cavity with
internal debris in the upper
renal pole. Note the mild
hydronephrosis ſt. (Courtesy
A. Pandya, MD.)
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