Unusual Presentation of Genitourinary Tuberculosis

Posted By Ankita Chauhan
Unusual Presentation of Genitourinary Tuberculosis

ABSTRACT The most common location of the extrapulmonary tuberculosis is the genitourinary tract. The putty kidney is the result of end-stage renal tubercular infection wherein the dense dystrophic calcifications may entirely outline a nonfunctional kidney (auto-nephrectomy). We are reporting a case of the putty kidney, diffuse ureteral calcification, and obstructive uropathy with associated chronic renal failure in a 65-year-old man with a history of pulmonary tuberculosis 30 years back. USG findings were suboptimal due to excessive posterior acoustic shadowing. Corresponding conventional radiograph, CT, and MRI confirms the amorphous pelvicalyceal and ureteric calcification along its length. No clinical, laboratory or radiological evidence of reactivation of tubercular process. CASE REPORT A 65-year-old man with abdominal discomfort came from the surgery OPD for USG abdomen. USG reveals a right pelvic-ureteric junction calculus with associated moderate hydronephrosis. The hydronephrotic right kidney shows peripheral parenchymal calcifications and few mobile secondary calculi within dilated PCS (Figure 1). Due to suboptimal visualization of left kidney and ureter on USG as amorphous calcification with dense posterior acoustic shadowing (Figure 2), Digital radiographic correlation was done. Digital radiograph of KUB region revealed multilobulated calcific and shrunken left reniform outline and dense calcification along dilated upper and mid left ureter and focal segmental narrowing of the ureteric segment at the pelvic brim, beyond which thinner calcified ureter continues. There is large right pelvi-ureteric calculus with smaller radiopaque shadow(calcification) along the right renal mid-polar region. Dense calcifications seen in pelvis along left superior pubic ramus could be vesical or prostatic in origin. No associated spinal anomaly noted (Figure 3). Non-contrast computed tomography (NCCT) revealed multilobulated calcific left renal outline without any discernible renal parenchyma and calcified ureteric outline along its length from pelvi-ureteric junction till vesicoureteric junction (Figure 4). Also, the reconstructed images reveal short-segment narrowing (stricture) at the pelvic brim (Figure 5). The right PUJ staghorn calculus is causing moderate hydronephrosis and thinning of cortical parenchyma. Calcification also is seen in the left paramedian region of the prostate. On MRI, left kidney shows T1T2 hypointense (calcific) renal outline (Figure 6). Static heavily T2-weighted MR urography images affirm non-visualisation of bilateral ureters and most of the left kidney (Figure 7). There was no evidence of pre-or-para-vertebral collection on CT and MRI. The patient underwent treatment for symptomatic chest tuberculosis 30 years back, and he was compliant with the medications. His recent chest radiograph shows no evidence of reactivation (Figure 8). Blood biochemical workup showed reduced hemoglobin (8.8), total leukocyte count and liver

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  • Ankita Chauhan 2016-06-03 06:41:53

    Diffuse long-segment homogeneous ureteric calcification in continuation with the putty kidney has not been reported in the literature so far. Due to early diagnosis, extensive renal tubercular involvement is not seen these days. The choice of imaging modality and spectrum of imaging findings is important as seen in our case. The contiguous extensive ureteric calcification along its length giving a dense “Pyeloureterogram” on plain skiagram is diagnostic when ultrasound evaluation due to dense acoustic shadowing is suboptimal. CT and MRI depict these changes and rule out associated spinal involvement.

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  • Roland Talanow 2016-06-01 13:09:51

    In case you wish to publish this case, what makes this so special? Please keep short. Thank you

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