(Professor and Head, Department of Obstetrics and Gynecology,
and K.E.M Hospital,
.) Mumbai, India
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.
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.
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.
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.
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3. Muttarak M1, ChiangMai WN, Lojanapiwat B. Tuberculosis of the genitourinary tract: imaging features with pathological correlation.
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