Predictability of Female Genital Tuberculosis by Hysterosalpingography

1
Predictability of Female Genital Tuberculosis by
Hysterosalpingography

• by Narayan M. Patel, MD, DGO, FICS
• Professor Emeritus, Ob/Gyn, N.H.L. Muni Medical
  College, Ahmedabad
• narayan_at_wilnetonline.net

2
Normal look of tubes at H.S.GNote wavy outline
of tubes with both side spill.
3
Rigid pipe line tubes of proved Koch's
4
No. 2 specimen after hysterectomy
5
Right tube lead pipe Intravasation left side
6
Both tubes lead pipe type
7
Tubes straight typical terminal ends looking
like sperm head
8
Both tubes eroded looking. Inner lining of
uterine cavity moth-eaten appearance
9
Both terminal ends of tubes dilated
10
Both terminal ends of tubes dilated
11
Beaded appearance more on left side
12
Beaded appearance more on left side
13
Unicornate Ut. intravastion of dye into
myometrium and vessel's
14
Intravasation of dye into myometriums and
lymphatic and terminal hydrosalpingx
15
Appearance similar to Bilateral tubal ligation.
Elongation and dilatation of cervical canal
16
Greenberg has described it as tobacco-pouch or
mail-pouch appearance of the fimbriated extremity
17
Bilateral terminal hydrosalpingx right tube shows
nodularity
18
Left terminal hydrosalpingx and right cornual
block
19
Left terminal hydrosalpingx, filling defect in
left tube, right tube thick but patent
20
Elongation crypts in cervical canal
21
Left tube appears as if tubectomy done also
described as look of sperm head
22
Left tubes -as if tubectomy done also beaded
appearance typical- of Koch's
23
Appearance similar to Bilateral tubal ligation.
Elongation and dilatation of cervical canal
24
Appearance similar to Bilateral tubal ligation.
Elongation and dilatation of cervical canal
25

• The appearance of Kochs tubes is similar To
  Bilateral tubal ligation. - John Richmond
• Similar look like that of Sperm head. - Narayan
  Patel

26
Unicornate uterus, sperm head appearance of
terminal end of tube, dilated cervical canal
27
Previous patient on injecting more dye.
Intravasation into myometrium lymphatics
28
Intravasation of dye into myometriums and
lymphatics and left terminal hydrosalpingx
29
Bilateral cornual block intravastion of dye in
vessels lymphatics.
30
Bilateral Rigid pipeline tubes with intravastion
of contrast
31
Bilateral cornual block intravastion
32
Bilateral Cornual block with intra myometrial
intravastion
33
Bilateral Cornual block, cervical dilatation
34
Dwarfed uterus, bilateral Cornual block
35
Deformed uterus, Not bicornuate uterus
36
Expansion and elongation cervix.
37
Intravasation of contrast in to tubal
musculature-? S.I.N.
38
Same tubes after removal
39
Severe form of Salpingitis isthamica nodosa
40
Tubes after removal
41
Bilateral T.O.masses even after AKT
42
Bilateral Salpingo-oophorectomy done
43
Bilateral hydrosalpingx AKT given for 2 yr
44
Develop fibroid hence Hysterectomy
45
It is always better to perform H.S.G. with image
Intensifier facility.

• Always use water soluble contrast.
• Always take minimum 2 x-rays.
• As per Michel's text book of infertility, the
  most diagnostic study for genital tuberculosis is
  H.S.G.
• H.S.G. which is properly performed and
  interpreted, can be of great value in the
  diagnosis of genital tuberculosis

46
Following radiological H.S.G. features are fairy
typical of genital tuberculosis

• Rigid pipe-stem tubes
• A clubbed ampula with retort shaped hydrosalpingx
• Vascular or lymphatic intravastion of contrast.
• Small shrunken uterine cavity with filling
  defects
• long and dilated Cervical canal dye in cervical
  crypts
• Bilateral Cornual block
• Punctate opacification of crypts and
  diverticula's in lumen of tubes