scholarly journals All in one, a rare case presentation of genitourinary tuberculosis

2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Vishwajeet Singh ◽  
Manoj Kumar ◽  
S. K. Pavan Kumar ◽  
Mayank Jain
Keyword(s):  
Pulmonary Tuberculosis ◽  
Renal Scarring ◽  
Imaging Techniques ◽  
Obstructive Uropathy ◽  
Developed Countries ◽  
Intravenous Urography ◽  
Case Presentation ◽  
Contrast Enhanced Ct ◽  
Urogenital Tuberculosis ◽  
Collecting System

Abstract Background The kidneys are the most common site of urogenital tuberculosis. Tuberculosis of the urethra and bladder is caused by a descending infection through the urinary collecting system. Urogenital tuberculosis affects 2% to 10% of pulmonary tuberculosis cases in developed countries, but 15% to 20% in developing countries. Case presentation A 55-year-old male referred to us with bilateral percutaneous nephrostomy, which was done for obstructive uropathy with raised creatinine of 4.5 mg/dl. He was diagnosed with pulmonary tuberculosis two years back and took antitubercular therapy for one year. His routine blood parameters were within normal limits. On evaluation with bilateral nephrostograms, he was found to have right-sided pelvic ureteric junction stricture and left-sided vesicoureteric junction stricture. On retrograde urethrography, there was evidence of 4-cm stricture at proximal bulbar urethra. On contrast-enhanced CT whole abdomen, he was found to have small-sized right kidney and findings in par with nephrostogram with thickened, small capacity bladder (thimble bladder). Patient underwent urethroscopy and urethral dilatation followed by augmentation ileocystoplasty with left ureteric reimplantation and right nephrectomy done at 3 months of follow-up. Conclusion Only 1.9 percent to 4.5 percent of all cases of urogenital tuberculosis are urethral tuberculosis, and it never happens alone. For urogenital tuberculosis diagnosis, imaging techniques are up to 91.4 percent sensitive, with intravenous urography and abdominal computerised tomography being the most widely used. Diagnosis relies on a range of signs such as “caliceal irregularities; infundibular stenosis; pseudotumor or renal scarring; nonfunctioning kidney; renal cavitation; urinary tract calcification (present in 7% to 19% of cases); collecting system thickening, stenosis, or dilatation; contracted bladder”.

Obstructive uropathy in the context of ureteroinguinal hernia: experience of challenges in surgical management of an unwell patient

2020 ◽  
Vol 13 (8) ◽  
pp. e235060
Author(s):  
Mitchell Egerton Barns ◽  
Arvind Vasudevan ◽  
Emma Lucy Marsdin
Keyword(s):  
Obstructive Uropathy ◽  
Anatomical Variation ◽  
Surgical Patients ◽  
Definitive Treatment ◽  
Ureteric Stent ◽  
Common Presentation ◽  
Iatrogenic Damage ◽  
Vesicoureteric Junction ◽  
Collecting System

This case exemplifies an unusual anatomical variation of a common presentation and highlights the importance of perioperative diagnosis and planning in complex surgical patients. A 72-year-old comorbid man presented to the emergency department with an infected obstructed right kidney secondary to an obstructing 12 mm vesicoureteric junction calculi. However, imaging also showed concurrent ureteroinguinal hernia associated with a 130 cm-long ureter, too long for conventional treatment with a ureteric stent. Acutely, the patient’s collecting system was decompressed via nephrostomy, but due to the rarity of this anatomical variation, definitive treatment had to be rethought to help reduce the risk of iatrogenic damage and the associated long-term complications.

scholarly journals Hookworm infection in infants: a case report and review of literature

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
G. Umbrello ◽  
R. Pinzani ◽  
A. Bandera ◽  
F. Formenti ◽  
G. Zavarise ◽  
...  
Keyword(s):  
Rural Areas ◽  
Simulation Models ◽  
Developed Countries ◽  
Hookworm Infection ◽  
Case Presentation ◽  
Abdominal Symptoms ◽  
Asymptomatic Children ◽  
Ancylostoma Duodenale ◽  
Stool Analysis ◽  
The Tropics

Abstract Background Hookworm infections (Necator americanus, Ancylostoma duodenale) are common in rural areas of tropical and subtropical countries. Human acquisition results from direct percutaneous invasion of infective larvae from contaminated soil. Overall, almost 472 million people in developing rural countries are infected. According to simulation models, hookworm disease has a global financial impact of over US$100 billion a year. Hookworm infection in newborn or infancy is rare, and most of the cases reported in literature are from endemic countries. Here, we describe the case of an infant with an Ancylostoma duodenale infection and review the literature currently available on this topic. Case presentation An Italian 2-month-old infant presented with vomit and weight loss. Her blood exams showed anemia and eosinophilia and stool analysis resulted positive for hookworms’ eggs, identified as Ancylostoma duodenale with real time-PCR. Parasite research on parents’ stools resulted negative, and since the mother travelled to Vietnam and Thailand during pregnancy, we assumed a transplacental transmission of the infection. The patient was treated successfully with oral Mebendazole and discharged in good conditions. Discussion Hookworm helminthiasis is a major cause of morbidity in children in the tropics and subtropics, but rare in developed countries. Despite most of the patients is usually asymptomatic, children are highly exposed to negative sequelae such as malnutrition, retarded growth and impaired cognitive development. In infants and newborns, the mechanism of infection remains unclear. Although infrequent, vertical transmission of larvae can occur through breastfeeding and transplacentally. Hookworm infection should be taken into account in children with abdominal symptoms and unexplained persistent eosinophilia. The treatment of infants infected by hookworm has potential benefit, but further studies are needed to define the best clinical management of these cases.

scholarly journals A Rare Case of Urinary Tract Fungal Ball Leading to Fungemia and Bilateral Chorioretinitis

2020 ◽  
Vol 2020 ◽  
pp. 1-4
Author(s):  
Christopher Ferari ◽  
Chad Crigger ◽  
Chad Morley ◽  
David Duchene
Keyword(s):  
Urinary Tract ◽  
Type Ii Diabetes ◽  
Rare Complication ◽  
Obstructive Uropathy ◽  
Treatment Options ◽  
Type Ii ◽  
Invasive Treatment ◽  
Case Presentation ◽  
Fungal Ball

Background. Fungemia due to obstructive urinary tract fungal ball is exceedingly rare. These patients often have multiple predisposing conditions, including diabetes or antimicrobial exposure. While candiduria can be relatively common in this population, urinary tract fungal balls are a rare entity. Hospitalists should be aware of this rare complication in patients presenting with funguria. Case Presentation. We present a case of a 44-year-old male with type II diabetes, chronic hepatitis C secondary to injection drug use, and chronic kidney disease who developed a urinary tract fungal ball leading to fungemia and subsequent bilateral chorioretinitis, additionally complicated by emphysematous cystitis and pyelonephritis. Additional invasive treatment options beyond typical antifungals are often required in the case of urinary tract fungal ball, and in this case, bilateral nephrostomy tubes and micafungin were employed. Hospital course was complicated by C. tropicalis fungemia with subsequent bilateral fungal chorioretinitis on dilated fundus exam. This was effectively treated with cyclogyl and prednisolone drops along with bilateral voriconazole injections. Follow-up imaging and cultures showed resolution of fungemia, urinary tract masses, and chorioretinal infiltrates; however, recurrent polymicrobial UTIs continue to be an issue for this patient. Conclusions. Special multidisciplinary management is required in the treatment of urinary tract fungal balls with subsequent fungemia, including nephrostomy tubes, antifungal irrigation, ureterorenoscopy, and more powerful antifungals such as amphotericin B and 5-flucytosine. This management draws from a myriad of specialties, including urology, infectious disease, and interventional radiology. Additionally, the literature has demonstrated that only approximately half of patients with fungemia receive an ophthalmologic evaluation. Ophthalmologic and urologic cooperation is essential in the case of obstructive uropathy leading to fungemia as the obstructive uropathy must be relieved and these patients should receive a dilated fundus exam.

scholarly journals DUETS (Dallas UtErus Transplant Study): The role of imaging in uterus transplantation

2019 ◽  
Vol 7 ◽  
pp. 205031211987560 ◽  
Author(s):  
Soran Mahmood ◽  
Liza Johannesson ◽  
Giuliano Testa ◽  
Gregory de Prisco
Keyword(s):  
Imaging Techniques ◽  
Vascular Anatomy ◽  
Evaluation Process ◽  
Living Donors ◽  
Important Variable ◽  
Donor Selection ◽  
Preoperative Imaging ◽  
Uterus Transplantation ◽  
Contrast Enhanced Ct

Objective: Uterus transplantation is rapidly becoming a viable clinical option for women with uterine-factor infertility and a desire for parenthood. Radiological imaging plays a central role in selecting the optimal living donors for uterus transplantation and serves to exclude any pathology and evaluate the uterine vasculature. The latter is the most important variable in the ultimate technical success of the uterus transplant. In this first report of imaging in the setting of uterus transplantation, we report our experience with living-donor selection, and the evolution of the imaging techniques that ultimately allowed a significant improvement in donor selection and transplant outcome. We also suggest a framework for preoperative imaging in uterus transplantation. Methods: Between 2016 and 2018, 27 potential living donors were evaluated by imaging prior to uterine donation for uterus transplantation. Predonation imaging included a screening chest radiograph, dual-phase computed tomography (CT) angiograms of the abdomen and pelvis in the arterial and venous phases and pelvic sonography with Doppler. Seventeen potential donors additionally underwent multiphasic pelvic MR angiograms. The imaging performed was meant to display features of the vascular anatomy relevant for uterus transplantation. Results: Out of the 27 potential live donors who were evaluated by imaging, 9 eventually donated their uterus for transplantation. The most frequent reason for exclusion was suboptimal quality of the vessels (33%), including small uterine arteries, the presence of atherosclerosis or small size/poor quality of the uterine or utero-ovarian veins, or both. The next most common reason was voluntary patient withdrawal or failure to complete the evaluation process (28%). Three potential donors (16.6%) were rejected for uterine factors, fibroids, and/or adenomyosis. Other reasons for donor rejection included ABO incompatibility and unfavorable psychological evaluation. Conclusion: Diagnostic imaging plays a crucial role in selecting appropriate potential donors, screening prospective recipients, planning the graft procedure, and following up on any graft or nongraft-related complications in both the donor and recipient after the transplantation procedure is performed. Contrast-enhanced CT and MR angiographies have complementary roles, especially when evaluating the donor for adequacy of the arterial and venous supply to the uterine graft and the experience gained from our series indicates that the inclusion of both modalities contributed directly to successful uterus transplant graft survival by selecting patients with favorable arterial and venous vasculature.

scholarly journals Renal abscess with bacteremia caused by extended-spectrum β-lactamase-producing Escherichia coli: a case report

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Hiroki Kitaoka ◽  
Jun Inatomi ◽  
Hayato Chikai ◽  
Keiko Watanabe ◽  
Tadayuki Kumagai ◽  
...  
Keyword(s):  
Escherichia Coli ◽  
Renal Scarring ◽  
Left Kidney ◽  
Severe Form ◽  
Healthy Children ◽  
Renal Abscess ◽  
Case Presentation ◽  
E Coli ◽  
Extended Spectrum ◽  
Low Density Area

Abstract Background Renal abscess in children is a rare and severe form of infectious kidney disease that is responsible for several serious complications. In this report, we describe a previously healthy 5-year-old girl with a renal abscess caused by extended-spectrum β-lactamase (ESBL)-producing Escherichia coli (E. coli), which led to bacteremia and renal scarring. Case presentation The patient presented to our department with high fever, headache, vomiting for 2 days and high inflammatory response. We diagnosed her with a urinary tract infection and initiated treatment with ampicillin and cefotaxime. Gram-negative bacilli bacteremia was noted on day 3. On day 4, her fever persisted, and a computed tomography (CT) scan revealed a renal abscess in the left kidney. After identifying the bacteria as ESBL-producing E. coli from the blood culture, we switched to the antibiotic meropenem and continued treatment for 3 weeks. The renal abscess was not drained. Although the renal abscess was successfully treated and it disappeared, a low-density area remained in same lesion on subsequent CT scans and a dimercaptosuccinic acid renal scan performed 4 months after onset revealed renal scarring. Conclusion Given the increasing prevalence of ESBL-producing microorganisms, clinicians should be aware of the possibility of renal abscesses caused by community-acquired ESBL-producing organisms even in previously healthy children. Once a renal abscess is suspected, early diagnosis and management are important for reducing the risk of life-threating complications and renal scarring.

scholarly journals The Role of Imaging in the Management of Cardiorenal Syndrome

2011 ◽  
Vol 2011 ◽  
pp. 1-7 ◽  
Author(s):  
Sajid Melvin George ◽  
Kambiz Kalantarinia
Keyword(s):  
Clinical Utility ◽  
Imaging Techniques ◽  
Obstructive Uropathy ◽  
Kidney Injury ◽  
Cardiorenal Syndrome ◽  
Renal Ultrasound ◽  
Resonance Imaging ◽  
Contrast Enhanced ◽  
And Function

Imaging of the kidney and the heart can provide valuable information in the diagnosis and management of cardiorenal syndromes. Ultrasound- (US-) based imaging (echocardiogram and renal US) is an essential component in the initial diagnostic workup of CRS. Echocardiography provides information on the structure and function of heart, and renal ultrasound is useful in differentiating between acute and chronic kidney disease and excluding certain causes of acute kidney injury such as obstructive uropathy. In this paper we overview the basic concepts of echocardiogram and renal ultrasound and will discuss the clinical utility of these imaging techniques in the management of cardiorenal syndromes. We will also discuss the role of other imaging modalities currently in clinical use such as computerized tomography and magnetic resonance imaging as well as novel techniques such as contrast-enhanced ultrasound imaging.

scholarly journals Gambaran Kejadian Hemoptisis pada Pasien di Bangsal Paru RSUP Dr. M. Djamil Padang Periode Januari 2011 – Desember 2012

2014 ◽  
Vol 3 (3) ◽  
Author(s):  
Intan Irfa ◽  
Irvan Medison ◽  
Detty Iryani
Keyword(s):  
Pulmonary Tuberculosis ◽  
Frequency Distribution ◽  
History Of Education ◽  
Cardiovascular Disorder ◽  
Developed Countries ◽  
Age Group ◽  
History Of ◽  
Retrospective Study Design ◽  
Descriptive Survey

AbstrakHemoptisis adalah ekspektorasi darah yang berasal dari saluran pernafasan bagian bawah dengan jumlah minimal hingga masif yang dapat membahayakan jiwa. Etiologi hemoptisis seperti infeksi, neoplasma dan kelainan kardiovaskular berbeda kekerapannya di berbagai negara. Di Indonesia dan negara berkembang lainnya, tuberkulosis paru merupakan penyebab utama hemoptisis. Tujuan penelitian ini adalah untuk mengetahui gambaran kejadian hemoptisis pada pasien di bangsal paru RSUP Dr. M. Djamil Padang periode Januari 2011 – Desember 2012. Metode yang digunakan adalah deskriptif secara retrospektif menggunakan data rekam medis pasien rawat inap dengan hemoptisis di bangsal paru RSUP Dr. M. Djamil Padang periode Januari 2011 – Desember 2012. Hasil penelitian menunjukkan bahwa sejak Januari 2011 – Desember 2012 terdapat 103 kejadian hemoptisis dan prevalensi kejadiannya sebesar 3,6%. Sebagian besar pasien dengan hemoptisis adalah laki-laki (65%) dengan kelompok usia terbanyak yaitu 31 – 40 tahun. Sementara distribusi frekuensi pasien dengan hemoptisis berdasarkan riwayat pendidikan terbanyak yaitu tamat SLTA (32%), berdasarkan pekerjaan adalah ibu rumah tangga (29,1%) dan sebagian besar berdomisili di Kota Padang. Klasifikasi hemoptisis terbanyak adalah hemoptisis sedang (34%) dengan etiologi utama tuberkulosis paru (47,6%). Pada penelitian ini didapat angka kematian pasien sebesar 6,8% dari total kejadian hemoptisis.Kata kunci: hemoptisis, prevalensi, tuberkulosis AbstractHemoptysis is expectoration of blood from the lower respiratory tract that varies in amount of blood from small amount to the massive amount and can become threaten of life. The etiology of hemoptysis such as infection, neoplasm and cardiovascular disorder are vary over the world. In Indonesia and other developed countries, pulmonary tuberculosis is a main etiology of hemoptysis. The purpose of this study is to determine the profile of hemoptysis among patients admitted in Pulmonary Department of Dr. M. Djamil Hospital Padang period January 2011 – December 2012. This research was a descriptive survey based on retrospective study design that reviewed the medical record of hospitalized patients with hemoptysis in Pulmonary Department of Dr. M. Djamil Hospital period January 2011 – December 2012. The result has shown that since January 2011 – December 2012 there were 103 patients with hemoptysis, and the prevalence of hemoptysis is 3.6%. Most of patients with hemoptysis are male (65%) with highest frequency distribution based on age group of patients is 31 – 40 years old. While the highest frequency distribution based on patients’ history of education is high school diploma (32%), based on patients’ profession is housewife (29.1%) and most of patients live in Padang. Moderate hemoptysis (34%) were the highest frequency distribution based on classification of hemoptysis, with pulmonary tuberculosis as the main etiology (47.6%). Mortality rate of patients with hemoptysis in this study was 6,8% of all hemoptysis cases.Keywords: hemoptysis, prevalence, tuberculosis

scholarly journals Dual-Energy Computed Tomography Lung in patients of Pulmonary Tuberculosis

2020 ◽  
Vol 10 ◽  
pp. 39
Author(s):  
Ahmad Umar Khan ◽  
Sachin Khanduri ◽  
Zikra Tarin ◽  
Syed Zain Abbas ◽  
Mushahid Husain ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Pulmonary Tuberculosis ◽  
Imaging Techniques ◽  
Ground Glass Opacity ◽  
Signs And Symptoms ◽  
Dual Energy ◽  
Dual Energy Ct ◽  
High Resolution Computed Tomography ◽  
Cross Sectional ◽  
Pulmonary Tb

Objectives: The objective of this study was to characterize findings of high-resolution computed tomography (HRCT) and dual-energy CT (DECT) (80 keV, 140 keV, and mixed) in pulmonary tuberculosis (TB) patients and to compare and correlate HRCT and DECT findings. Material and Methods: This cross-sectional study was conducted on 67 patients of 18–65 years of age who were suspected cases of pulmonary TB with signs and symptoms of cough, fever, hemoptysis, sputum, night sweats, and weight loss with positive sputum AFB examinations/bronchoalveolar lavage. All the patients subjected to HRCT scan and followed with DECT scan. Comparison of various imaging techniques (DECT 80 keV, DECT 140 keV, and DECT mixed) with HRCT was done for detecting lung findings and data so obtained were subjected to statistical analysis. Results: On comparing the various imaging techniques with HRCT for detecting consolidation, tree in bud pattern, cavitary lesions, ground-glass opacity, bronchiectasis, atelectasis, nodules, granuloma, peribronchial thickening, and fibrosis, the maximum agreement of HRCT was found with DECT 80 keV and minimum agreement was found with DECT 140 keV. Conclusion: The study concluded that DECT 80 keV monochromatic reconstructions among 80 keV, mixed, and 140 keV monochromatic reconstructions in lung parenchyma window settings are a faster and better analytical tool for the assessment of findings of pulmonary TB when compared with HRCT.

scholarly journals Stage 4 Lung Cancer with Brain and Pericardial Metastases Which Are First Considered as Pulmonary Tuberculosis Infection and Heart Failure

2020 ◽  
Vol 16 (2) ◽  
pp. 127
Author(s):  
Haryati Haryati ◽  
Marsheilla Riska
Keyword(s):  
Lung Cancer ◽  
Pericardial Effusion ◽  
Pulmonary Tuberculosis ◽  
Tyrosine Kinase ◽  
Ct Scan ◽  
Kinase Inhibitor ◽  
Clinical Symptoms ◽  
Egfr Mutations ◽  
Contrast Enhanced Ct ◽  
Patient Reported

Abstract: Lung cancer and pulmonary tuberculosis become a global problem in the world. The similarities of clinical symptoms and radiological appearances often complicates diagnosis especially in TB endemic countries. A 43-year-old man presented with shortness of breath for 6 months, accompanied by intermittent cough mixed with blood streaks. He had been taking anti-tuberculosis for 2 months, but there’s no improvement. On physical examination, ronchi were heard in the lower 2/3 of the right lung and heart sounds diminished. Motoric movement of the left hand was difficult to grasp hard. A contrast-enhanced CT scan of the head revealed hyperdense multiple nodules. Chest X-ray showed cardiomegaly with right lung consolidation and a primary malignant right lung mass accompanied by pericardial effusion at thoracic CT scan. Cytology and EGFR examination of pericardial effusion found adenocarcinoma metastasis with exon 18 and 21 mutations. Evaluation of clinical symptoms and radiological examination during tyrosine kinase inhibitor (TKI) therapy showed improvement. Lung cancer can resemble pulmonary tuberculosis in various manifestations. Adenocarcinoma with positive EGFR mutations is more commonly found in Asians. Cytology and EGFR examination of pericardial effusion became the basis of diagnosis in this case. He was given TKI therapy. Re-evaluation must be carried out in patients who do not improve with antibiotics or anti-tuberculosis. Patient reported a good response after consuming EGFR-TKI. Keywords: lung cancer, tuberculosis, tyrosine kinase inhibitors

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