Answer of February 2006

Clinical History:

A 54-year-old lady presented with gross hematuria and fever.

Diagnosis:

Tuberculosis infection

Discussion:

IVU showed almost nil contrast excretion from the right kidney, suggestive of non-functioning status. Bladder volume was small and a Hutch's diverticulum was incidentally found over the left ureteral hiatus.

CT scan of abdomen revealed grossly enlarged right kidney with impaired contrast enhancement. It had dilated pelvicaliceal system and thinning of renal cortex. The right pararenal fascia was thickened, indicating inflammatory changes. Circumferential ureteric wall thickening and urinary bladder wall thickening were present. The ureter itself was not dilated, pointing to a stricture at the ureteropelvic junction causing obstruction and hydronephrosis. The bladder volume was again small. The left kidney and ureter were unremarkable. The diagnosis is tuberculosis infection of the right urinary tract and urinary bladder.