Hashmi, R

Masroor, I

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eCommons@AKUDepartment of Radiology Medical College, PakistanApril 2002View box case--4 Left sided tuberculousautonephrectomyI MasroorAga Khan University, imrana.masroor@aku.eduR HashmiFollow this and additional works at: https://ecommons.aku.edu/pakistan_fhs_mc_radiolPart of the Radiology CommonsRecommended CitationMasroor, I., Hashmi, R. (2002). View box case--4 Left sided tuberculous autonephrectomy. Journal of Pakistan Medical Association,52(4), 187-188.Available at: https://ecommons.aku.edu/pakistan_fhs_mc_radiol/292View Box Case - 4I. Masroor,R. Hashmi  ( Department of Radiology, Aga Khan University Hospital, Karachi. ) A 55 years old male, known case of genitourinary tuberculosis, presented with fever, abdominal painand pyuria. On examination he was tender in left lumbar area. Laboratory findings showed increasedwhite cell count of 15,000and increased ESR. Urine analysis revealed frank pus with few red bloodcells. Plain film of the abdomen showed irregular dense calcification in the left renal area opposite thetransverse processes of L1-L3 vertebral bodies. There was also dense tubular calcification in line of leftdistal ureter (Figure 1).Intravenous pylography showed normally excreting right urinary system with a non-excreting systemon left side till 24 hours (Figure2).Ultrasound examination gave a finding of dense irregular calcification with distal shadowing in leftrenal area and the normal kidney was replaced by this calcification.Diagnosis: Left sided tuberculous autonephrectomy.Discussion Tuberculosis of the urinary tract continues to be an important clinical problem due to its non-specificclinical presentation and a variable radiographic appearance. Predominant between second and thirddecades, men are affected more frequently than women. More than half of the patients have some lungabnormality indicative of past pulmonary tuberculosis. Clinically the patient presents most commonlywith irritative symptoms and less commonly with fever, anorexia, and weight loss1. Mycobacteriurntuberculosis is the causative organism of urinary tract tuberculosis. Discharge of M. tuberculosis froman active source of infection leads to the formation of miliary tuberculomas in the kidneys. Fewtubercies regress while some enlarge and rupture into a nephron producing tuberculous bacilluriawithout a radiographic lesion.The granulomas affect the medulla and the papillae and coalesce to form a cavity communicating withthe pelvicalyceal system. There is resultant destruction of the parenchyma with localized hydrocalicosisdue to stricture of the infundibulum or the caliceal neck. Finally, autonephrectomy of the kidney leadsto a non-functioning calcified kidney. The involvement of the ureter occurs due to passage of infectedurine through the ureter or refluxly from an infected bladder leading to mucosal wall ulceration,fibrosis, stricture and calcification. Bladder cystitis leads to a small capacity bladder called a thimblebladder.Technology has permitted significant advances in imaging and early diagnosis and treatment of manyserious urinary tract infections2. Each modality has its own contribution. Early changes are bestevaluated with urography/pyelography and chronic changes are best evaluated withultrasound/computed tomography. Imaging procedures are of limited value until a proven bacteriologicdiagnosis is made3. Plain films are done to evaluate lung lesions and abdominal calcification ofadrenals, lymph nodes and in the renal areas. Excretory urogram is the modality of choice for thevisualization of pelvicalyceal system and helps in the early detection of renal tuberculosis.Ultrasonography demonstrates focal renal lesions with an echogenic border and central area of lowechogenicity. It also shows calcification and perinephric abscesses. Computed tomography helps in thedetection of fine calcifications and presence of disease in the adjacent genital tract. Treatment consistsof antituberculous chemotherapy in all patients in combination with surgery and/or endoradiologicalprocedures. Nephrectomy is indicated for non-functioning tuberculous kidneys in order to prevent thedevelopment of hypertention, abscess and fistulas formation.References 1.EI Khader K, Lrhorfi MH,EI Fassi J. Urogenital tuberculosis. Experirnce in 10 years Prog.Urol.,2001;11:62-7.  2.Benson M, Li Puma JP, Rcsnick MI. The role of imaging studies in urinaiy tract infections. Urol.Clin. North. Am., 1986; 13: 605-25.3.Becker JA. Renal Tuberculosis, Urol. Radiol., 1988; 10: 25.30.

View box case--4 Left sided tuberculous autonephrectomy

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View box case--4 Left sided tuberculous autonephrectomy

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