Tuberculous salpingitis

Because of the lack of clinical signs, the diagnosis of genital TB is problematic. A definitive diagnosis can be made by endometrial biopsy and microbiologic examination, and can be suggested by hysterosalpingography (HSG) findings of abnormalities within the uterus and Fallopian tubes. The HSG appearance in TB salpingitis varies as widely as do the pathological changes seen in this condition. Tubal involvement in cases of TB is always bilateral, but varying degrees of involvement can be present on the two sides. HSG may also demonstrate sacculation with infiltration of contrast material, resembling SIN. Infiltration of contrast around the tube, which gives a "cloud-like" appearance, or delicate sinus tracts have also been described. There may also be an irregular distribution of contrast, resembling a "cotton wool" plug. The latter is considered a characteristic feature of TB. Focal strictures which give the tube a beaded appearance and calcifications within the tubal lumen are an additional feature of TB. In addition, the tube may shrink and exhibit loss of elasticity of the tubal wall. The tubal lumen may be constricted and broadens only slightly at its most distal filled portion. Tubal obstruction often accompanies tuberculosis, but is not pathognomonic of tubal TB. Hydrosalpinx is another feature of Fallopian tube TB. The dilatation at the terminal segment can be moderate or marked. In the fibrotic stage, the tubes are rigid, no peristalsis is detected, and the tube resembles a pipe-like conduit. Within the endometrial cavity, the findings of genital TB include adhesions which may vary from thin to very thick synechias, and, in the end stages of the disease, obliteration of the uterine cavity and marked irregularity of its contour. In the pelvis, calcifications of the pelvic lymph nodes and ovaries may be observed as well.

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