Imaging of Urogenital, Adrenal, and Breast Tuberculosis

Abstract

Many patients presenting with extrapulmonary tuberculosis (TB) have urogenital TB. Urogenital TB can easily be overlooked owing to non-specific symptoms, chronic and cryptic or protean clinical manifestations, and lack of clinician awareness of the possibility of TB. Although the definitive diagnosis of urogenital TB is established by culturing Mycobacterium tuberculosis or by DNA identification, the diagnosis is often difficult and delayed. Abnormal abdominal or chest radiographs are useful as the initial diagnostic investigation in a large proportion of infected patients. Intravenous urography and hysterosalpingography, the standard imaging modalities for the evaluation of urogenital TB in the past, are infrequently used nowadays in the era of cross-sectional imaging. Computed tomography, magnetic resonance imaging, and ultrasound imaging are useful, depending on which urogenital organs are investigated. Imaging features of TB affecting the adrenal gland and breast are also addressed. Awareness of the imaging findings enables the radiologist to raise the diagnostic suspicion in a timely manner, for initiation of prompt treatment and prevention of complications. Imaging can aid in localizing the site, extent, and effect of the disease, obtaining tissue samples for diagnosis, planning medical or surgical management, and monitoring the response to treatment.