Image
Author Information
Parulekar SV
(Professor and Head, Department of Obstetrics and
Gynecology, Seth G.S.
Medical College
and K.E.M Hospital ,
Mumbai , India
Abstract
Though genital tuberculosis is an extremely rare condition
in the developed countries, it is not so uncommon in the developing world. Its
diagnosis is often suspected on hysterosalpingography. some of its salient
features are seen in the image presented.
Introduction
Genital tuberculosis is an extremely rare condition in the
developed countries. However it continues to be an important cause of
infertility in women in the developing countries. It is often suspected when
characteristic features are seen on hysterosalpingography..[1,2,3] The diagnosis needs
to be confirmed by additional tests like hysteroscopy, laparoscopy, endometrial
histopathology and polymerase chain reaction. One image of a
hysterosalpingogram is presented here.
Image
Figure 1. Hysterosalpingogram in a case of genital
tuberculosis, showing shrunken uterus (U), irregular outline of the uterus
(green arrows), uterine synechiae (yellow arrows), beading of the right
fallopian tube (pink arrows), and lymphatic intravasation (blue arrows).
A 21 years old woman presented for evaluation of infertility.
She had hypomenorrhea for one year. Her past medical history was normal.
General, systemic and gynecological examination revealed no abnormality. Her hemogram,
hepatic and renal function tests, serum gonadotropin levels, Serum TSH and PRL
levels, urinalysis and chest radiogram were normal. Her husband’s semen
analysis was normal. Her hysterosalpingogram (figure 1) showed Irregular
contour of the uterus, shrunken uterine cavity, filling defects in the uterine
cavity, left tubal cornual block, right tubal beading, irregular outline and
ampullary block, and bilateral lymphatic intravasation of the dye. The
diagnosis of genital tuberculosis was confirmed by endometrial histopathology
later on.
Discussion
Endometrial tuberculosis results in endometrial ulceration
and subsequently fibrosis. This results in endometrial synechiae (filling
defects), shrinking, and irregular outline. The endometrium is deficient, which
causes intravasation of the dye. In the image presented, it was lymphatic, as
its nature is fine and uterine veins are not outlines. Tubal tuberculosis
produces ulceration of tubal epithelium, fibrosis in tubal wall producing
irregular tubal outline, constrictions (beading), blocks at different levels,
and calcification. All of these except the last feature are seen in the image
presented.
References
1.
Burrill J, Williams CJ , Bain G,
Conder G, Hine AL, Misra RR. Tuberculosis: A Radiologic Review RadioGraphics
2007 SepOct;27(5):1255-73.
2.
Harisinghani MG, McLoud TC,
Shepard JA, Ko JP, Shroff MM, Mueller PR. Tuberculosis from head to toe
RadioGraphics 2000 Mar-Apr;20(2):449-7.
3.
Muttarak M1, ChiangMai WN,
Lojanapiwat B. Tuberculosis of the genitourinary tract: imaging features with
pathological correlation. Singapore
Citation