journal club Genitourinary Tuberculosis ppt

Menifestations of Tuberculosis on Urogenital shystem.

1. Journal Club
Imaging Manifestations of Genitourinary
Tuberculosis
https://pubs.rsna.org/doi/epdf/10.1148/
rg.202120015433
Dr Hafiza Ayesha Jawaid

2. Objectives
Describe the most common imaging manifestations
of genitourinary TB.
List entities that can mimic various organ based
forms of genitourinary TB.
Discuss the pathophysiologic mechanisms of
genitourinary TB.

3. •The genitourinary region is one of the most common
sites of extra-pulmonary tuberculosis (TB) involvement.
•One in five patients with genitourinary TB has
extrapulmonary TB.
•Genitourinary TB accounts for approximately 30%–40%
of all extrapulmonary TB cases

4. •Genitourinary TB can be indolent and results in nonspecific signs and
symptoms; thus, imaging has a vital role in the working diagnosis for
these cases.
•Classic uroradiologic signs of genitourinary TB are primarily described
from the era of intravenous urography and conventional radiography.
•Now, CT, CT urography, MRI, and US are used in the diagnosis and
management.
•Familiarity with the imaging features of genitourinary TB may help
guide the diagnosis and, in turn, lead to timely management.
•US has a vital role in the evaluation of scrotal and female genital TB.
•MRI offers superior soft-tissue contrast resolution and excellent
depiction of anatomic detail.

5. Pathophysiologic mechanisms of genitourinary TB.

7. Adrenal Glands
•The adrenal gland is the most common endocrine site of
extrapulmonary TB
•Almost always bilateral, and this can lead to Addison disease.
Plain radiographs
•No specific imaging feature. Adrenal calcification
The CT Findings
•Mass like enlargement 50%–65% of cases,
•Adreniform hyperplasia 35%–50% of cases.
•Heterogeneous enhancement of the adrenal glands.
•Peripheral rim like enhancement

9. Renal Parenchyma and
Collecting System
•Renal TB is the most frequent form of genitourinary TB,
and it may be seen concomitantly in 10% of cases
involving active lung TB.
•Almost half of patients with renal TB have some imaging
evidence of prior pulmonary TB.
•Renal TB can be divided into two categories
1.Renal parenchymal involvement
2.Pelvicalyceal system involvement

10. Renal Parenchyma and Collecting
System

14. Pelvicalyceal System
•Earliest stages of disease usually manifests as
papillary necrosis or minor calyceal deformity.
•Once the papilla is necrotic, it can be absorbed
or sloughed off in urine, or calcify.
•Papillary sloughing leaves a cavity that
communicates with the collecting system.

21. Tuberculous abscesses associated with
renal TB

22. Ureter, Bladder, and Urethra
Ureters
• Antegrade urinary transit of renal TB granuloma from the
pelvicalyceal system can seed the ureters, bladder, and
urethra.
•With regard to the ureters, ureteral TB develops
concomitantly with renal TB in 50% of cases.
•The distal third of the ureter, followed by the ureteropelvic
junction, is the most common site of involvement

25. Urinary Bladder
Bladder TB is divided into four stages to guide the treatment strategy:
•Stage 1 tubercle-infiltrative bladder TB
•stage 2, erosive-ulcerous bladder TB
•stage 3, interstitial cystitis
•stage 4, contracted bladder to full obliteration.

28. Urethra
•Despite the constant exposure to Mycobacterium bacilli in cases of genitourinary TB,
urethral involvement is exceedingly rare in both sexes.
•When present, concomitant renal TB is seen in 4.5% of cases.
•Imaging may reveal concomitant prostatitis; however, strictures are rarely seen in the
acute setting.
•Chronic TB can manifest with urethral strictures (usually long segment) with multiple
associated fistulas into the perineum and surrounding regions that are outlined by
contrast material on fluoroscopic images (watering can perineum).

30. Male Genital Tract
•TB can involve any organ of the male genital tract.
•The clinical manifestations can vary and can mimic those of sexually
transmitted infections such as syphilis and gonorrhea.

31. Prostate
•The prostate is involved in 6.6% of cases of genitourinary TB.
•Prostatic TB can be asymptomatic and incidentally detected in a
transurethral resection specimen or prostate biopsy.
•Transrectal US is the preferred, it also aids in detailed evaluation of
the most commonly affected posterior and lateral lobes of the
prostate gland. Sonographic features include solitary or multiple
hypoechoic nodules or masses that can mimic prostate cancer.

34. Testes and Epididymides.
•Usually, the epididymis is involved initially, and if left untreated or
undertreated, the infection can spread to the testes.
•Isolated testicular TB is rare and can simulate malignancy or infarct.
•The clinical presentation is a painless or slightly painful scrotal
mass.
•US is the imaging modality of choice for evaluation of the scrotum.

36. Female Genital Tuberculosis
•Female genital TB can result in
•Infertility
•Menstrual irregularities
•Pelvic pain
•Abnormal vaginal discharge.
•In post- menopausal women, it can manifest as bleeding, resembling
endometrial malignancy.

37. Fallopian Tubes
•The fallopian tubes are most commonly in volved in
genital TB
•Both tubes are nearly always involved.
•The acute phase of tuberculous salpingitis is
exudative; hydrosalpinx or pyosalpinx may form,
but few adhesions are present.
•In contrast, the productive-adhesive form is most
commonly seen during surgery, at which the tubes
are thickened, nodular, and densely adherent to the
surrounding organs. Eventually, calcification and
fibrosis may occur owing to healing.

40. Uterus
•The infection generally is localized to the endometrium.
In initial stages findings are unremarkable.
•Later, ulcerative, granular, or fungating lesions.
•Advanced cases, the endometrial cavity may be
obliterated owing to intrauterine synechiae manifesting
as Asherman syndrome.
•HSG may reveal nonspecific findings such as synechia
formation, a truncated and deformed uterine cavity, and
venous and/or lymphatic intravasation.

48. findings
DDx