EURORAD ESR

Case 14115

Urinary tuberculosis: multidetector CT findings

Author(s)
Tonolini Massimo, M.D.; Bonzini Miriam, M.D.

"Luigi Sacco" University Hospital, Radiology Department; Via G.B. Grassi 74 20157 Milan, Italy; Email:mtonolini@sirm.org
 
Patient
male, 82 year(s)
 
 
  • Figure 1
    Unenhanced lumbar spine MRI and CT
     

    Sagittal T1-(a), STIR (b) and T2-weighted (c) images inflammatory-type signal changes (*) affecting the L4 and L5 vertebral bodies and fluid content in the intervertebral disk (arrows in b&c) suggesting infectious...

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Sagittal T1-(a), STIR (b) and T2-weighted (c) images inflammatory-type signal changes (*) affecting the L4 and L5 vertebral bodies and fluid content in the intervertebral disk (arrows in b&c) suggesting infectious...

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Sagittal T1-(a), STIR (b) and T2-weighted (c) images inflammatory-type signal changes (*) affecting the L4 and L5 vertebral bodies and fluid content in the intervertebral disk (arrows in b&c) suggesting infectious...

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Axial (d) and coronal (e,f) T2-weighted image revealed bilateral paravertebral abscesses (+), associated with fluid content in the intervertebral disk (arrow) suggesting tuberculous spondylo-diskitis.

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Note paravertebral abscesses (+), liquefied L4-L4 intervertebral disk (arrow). Additionally, moderate left-sided hydronephrosis (*), right kidney with parenchymal thinning, dilated and distorted calyces (thin arrows),...

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    Note paravertebral abscesses (+), liquefied L4-L4 intervertebral disk (arrow). Additionally, moderate left-sided hydronephrosis (*), right kidney with parenchymal thinning, dilated and distorted calyces (thin arrows),...

     
    Area of Interest: Spine; Imaging Technique: MR; Procedure: Diagnostic procedure; Special Focus: Infection;

    A sagittal CT reformatted image viewed at bone window settings showed destructive vertebral changes (*) corresponding to the MR signal changes in the L4 and L5 vertebral bodies.

     
    Area of Interest: Spine; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 2
    Chest radiographs
     

    Postero-anterior (a) and latero-lateral (b) chest radiographs did not show active pleuropulmonary changes nor mediastinal abnormalities. Note peripheral centimetric calcified nodule (arrowhead in a) in the left lung...

     
    Area of Interest: Lung; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Infection;

    Postero-anterior (a) and latero-lateral (b) chest radiographs did not show active pleuropulmonary changes nor mediastinal abnormalities. Note peripheral centimetric calcified nodule (arrowhead in a) in the left lung...

     
    Area of Interest: Lung; Imaging Technique: Plain radiographic studies; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 3
    Multidetector CT-urography - Precontrast and portal phase images
     

    Due to chronic renal impairment, the patient received intravenous hydration. Preliminary unenhanced acquisition excluded urinary tract calcifications, and confirmed left-sided hydronephrosis (*) and mild mural...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Nephrographic acquisition (b...f) showed left kidney with normal size and function, mild hydronephrosis (*). Right-sided findings included decreased renal parenchyma and delayed enhancement, uneven caliectasis (thin...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Nephrographic acquisition (b...f) showed left kidney with normal size and function, mild hydronephrosis (*). Right-sided findings included decreased renal parenchyma and delayed enhancement, uneven caliectasis (thin...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Detail nephrographic phase images better showed atrophied right kidney with thinned parenchyma and delayed enhancement, uneven caliectasis (thin arrows). Note left hydronephrosis (*), paraspinal abscesses (+).

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    Detail nephrographic phase images better showed mild enhancing urothelial thickening (thick arrows) along the right ureter, and bilateral paraspinal abscesses (+).

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    A short segmental stricture (arrow) with enhancing wall but no appreciable mass was noted at the distal left ureter, causing upstream hydronephrosis.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 4
    Multidetector CT-urography - excretory phase images
     

    The left-sided hydronephrosis (*) had associated normal excretory function. Conversely, the atrophied right kidney did not show opacified collecting systems after 8 minutes.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    A short segmental stricture (arrow) with mild circumferential mural thickness but no appreciable mass was confirmed at the distal left ureter, causing upstream hydronephrosis.

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    A short segmental stricture (arrow) with mild circumferential mural thickness but no appreciable mass was confirmed at the distal left ureter, causing upstream hydronephrosis. Incidental finding of multiseptated left...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;

    The well-distended bladder showed uniform, regular mural thickness. Incidental findings of multiseptated left hip effusion (§) and asymmetric enlargement of the right seminal vesicle with a 2x1 cm hypodense lesion...

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Diagnostic procedure; Special Focus: Infection;
     
     
  • Figure 5
    Cross-sectional imaging features suggesting urinary tuberculosis

    Table summarizes early and advanced cross-sectional imaging features alerting the radiologist to a possible diagnosis of urinary tuberculosis

     
    Area of Interest: Urinary Tract / Bladder; Imaging Technique: CT; Procedure: Technical aspects; Special Focus: Infection;
     
     
Sagittal T1-(a), STIR (b) and T2-weighted (c) images inflammatory-type signal changes (*) affecting the L4 and L5 vertebral bodies and fluid content in the intervertebral disk (arrows in b&c) suggesting infectious spondylo-diskitis.
 
Sagittal T1-(a), STIR (b) and T2-weighted (c) images inflammatory-type signal changes (*) affecting the L4 and L5 vertebral bodies and fluid content in the intervertebral disk (arrows in b&c) suggesting infectious spondylo-diskitis.
 
Sagittal T1-(a), STIR (b) and T2-weighted (c) images inflammatory-type signal changes (*) affecting the L4 and L5 vertebral bodies and fluid content in the intervertebral disk (arrows in b&c) suggesting infectious spondylo-diskitis.
 
Axial (d) and coronal (e,f) T2-weighted image revealed bilateral paravertebral abscesses (+), associated with fluid content in the intervertebral disk (arrow) suggesting tuberculous spondylo-diskitis.
 
Note paravertebral abscesses (+), liquefied L4-L4 intervertebral disk (arrow). Additionally, moderate left-sided hydronephrosis (*), right kidney with parenchymal thinning, dilated and distorted calyces (thin arrows), non-dilated pelvis with mild mural thickening (thick arrow) were noted.
 
Note paravertebral abscesses (+), liquefied L4-L4 intervertebral disk (arrow). Additionally, moderate left-sided hydronephrosis (*), right kidney with parenchymal thinning, dilated and distorted calyces (thin arrows), non-dilated pelvis with mild mural thickening (thick arrow) were noted.
 
A sagittal CT reformatted image viewed at bone window settings showed destructive vertebral changes (*) corresponding to the MR signal changes in the L4 and L5 vertebral bodies.
 
Postero-anterior (a) and latero-lateral (b) chest radiographs did not show active pleuropulmonary changes nor mediastinal abnormalities. Note peripheral centimetric calcified nodule (arrowhead in a) in the left lung consistent with past primary tuberculous infection.
 
Postero-anterior (a) and latero-lateral (b) chest radiographs did not show active pleuropulmonary changes nor mediastinal abnormalities. Note peripheral centimetric calcified nodule (arrowhead in a) in the left lung consistent with past primary tuberculous infection.
 
Due to chronic renal impairment, the patient received intravenous hydration. Preliminary unenhanced acquisition excluded urinary tract calcifications, and confirmed left-sided hydronephrosis (*) and mild mural thickening along the right renal pelvis and ureter (thick arrows).
 
Nephrographic acquisition (b...f) showed left kidney with normal size and function, mild hydronephrosis (*). Right-sided findings included decreased renal parenchyma and delayed enhancement, uneven caliectasis (thin arrows), mild enhancing urothelial thickening (thick arrows).
 
Nephrographic acquisition (b...f) showed left kidney with normal size and function, mild hydronephrosis (*). Right-sided findings included decreased renal parenchyma and delayed enhancement, uneven caliectasis (thin arrows), mild enhancing urothelial thickening (thick arrows).
 
Detail nephrographic phase images better showed atrophied right kidney with thinned parenchyma and delayed enhancement, uneven caliectasis (thin arrows). Note left hydronephrosis (*), paraspinal abscesses (+).
 
Detail nephrographic phase images better showed mild enhancing urothelial thickening (thick arrows) along the right ureter, and bilateral paraspinal abscesses (+).
 
A short segmental stricture (arrow) with enhancing wall but no appreciable mass was noted at the distal left ureter, causing upstream hydronephrosis.
 
The left-sided hydronephrosis (*) had associated normal excretory function. Conversely, the atrophied right kidney did not show opacified collecting systems after 8 minutes.
 
A short segmental stricture (arrow) with mild circumferential mural thickness but no appreciable mass was confirmed at the distal left ureter, causing upstream hydronephrosis.
 
A short segmental stricture (arrow) with mild circumferential mural thickness but no appreciable mass was confirmed at the distal left ureter, causing upstream hydronephrosis. Incidental finding of multiseptated left hip effusion (§).
 
The well-distended bladder showed uniform, regular mural thickness. Incidental findings of multiseptated left hip effusion (§) and asymmetric enlargement of the right seminal vesicle with a 2x1 cm hypodense lesion (black arrowhead).
 
Table summarizes early and advanced cross-sectional imaging features alerting the radiologist to a possible diagnosis of urinary tuberculosis
 
 
 
Home Search Sections Teaching Cases History FAQ Case Archives Contact Login Disclaimer Imprint Switch to MOBILE version
View desktop version