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Granulomatous renal masses following intravesical bacillus Calmette–Guérin therapy: the central unaffected calyx sign

¹ Hospices Civils de Lyon, Department of Urinary and Vascular Radiology, Hôpital Edouard Herriot, Lyon, F-69437, France, ² Hospices Civils de Lyon, Department of Urology, Hôpital Edouard Herriot, Lyon, F-69437, France, ³ Université de Lyon, Lyon, F-69003, France; Université de Lyon 1, Faculté de Médecine Lyon Nord, Lyon, F-69003, France, ⁴ Inserm, U556, Lyon, F-69424, France

View larger version (105K): [in this window] [in a new window]   Figure 1. Sonogram showing a solid mass on the right kidney(black arrow).

View larger version (86K): [in this window] [in a new window]   Figure 2. Axial contrast-enhanced CT images showing a slightly hypervascular solid mass on the right kidney (a: arrowhead, arterial phase imaging) with a normal calyx in its centre (b: arrow, excretory-phase imaging).

View larger version (98K): [in this window] [in a new window]   Figure 3. Excretory urogram of the right kidney. The calyx included in the mass shows neither distortion nor displacement(arrow).

View larger version (88K): [in this window] [in a new window]   Figure 4. Axial contrast-enhanced CT images, obtained at the same slice level as Figure 2, after 9 months of treatment with isoniazid, rifampine and ethambutol (a: arterial phase imaging; b: excretory-phase imaging). The granulomatous mass has completely disappeared and has been replaced by a focal area of parenchymal atrophy (arrows).