What is the most likely diagnosis?

• 41 year-old with frequency and dysuria

Unenhanced, coronal reformatted CT scan of abdomen

1. Ankylosing spondylitis
2. Medullary sponge kidney
3. Xanthogranulomatous pyelonephritis
4. Spina bifida
5. Renal tuberculosis

Additional Image - Axial CT scan of abdomen

 

 

Additional Images

 

Unenhanced, axial CT scan of abdomen

Answer:

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5. Renal Tuberculosis

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Renal Tuberculosis

General Considerations

• GU tract second most common site of tuberculous infection after lungs
• Males more commonly infected than females, most often < 50 years old
• Spread is hematogenous and usually occurs with primary exposure
  • Although may not be clinically apparent at this time, remaining latent for decades
• Active pulmonary TB seen only 4-8% of time
• Only about 25% of patients with GU TB have a known history of pulmonary TB

 

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