Vas deferens sonographic appearances of tuberculosis lesions of 19 cases of male genital systemic tuberculosis

Abstract

To investigate the sonographic findings of the vas deferens in male genital tuberculosis.The ultrasonographic findings of the vas deferens of 19 cases of genital tuberculosis were retrospectively analyzed.According to the pathological and ultrasound findings, the ultrasonographic appearances of the vas deferens tuberculosis could be divided into 4 groups, 1 of normal sonograms, 3 of abnormal sonograms. The abnormal ultrasonographic appearances of the vas deferens tuberculosis were considered 3 categories as follows: diffusely thickening of vas deferens, nodular thickening of vas deferens, and space-occupying lesions adjacent to the vas deferens.The ultrasound manifestations of vas deferens in tuberculosis of the male genital system have certain characteristics. Combination of clinical manifestations, history of tuberculosis, experimental antituberculosis treatment, and ultrasound examination of vas deferens can suggest tuberculosis of vas deferens. Furthermore, it can provide objective basis for the comprehensive and noninvasive evaluation of the impact of genital tuberculosis on the reproductive ability for further treatments.

Figure 1

Ultrasonographic appearances of the VD tuberculosis. (A) Normal sonogram of VD, (B) Diffusely thickening of VD, (C) Nodular thickening of VD, and (D) Space-occupying lesions adjacent to the VD. (As indicated by the white arrows, respectively.). VD = vas deferens.

Figure 2

VD tuberculosis ultrasound findings (category 1, nodular thickening) and pathology results. (A) White arrow shows that the right VD was segmentally thickened in scrotum. (B) The granuloma (white arrow) and caseous necrosis (black arrow) was found at the peripheral region of the VD in the picture of HE staining (×40) after the vasectomy. (C) In the acid-fast staining picture, the coral-red positive bacillus was visualized (black arrow). (D) The 2 lines represent the amplitution of the tuberculosis DNA fragments in the positive control group and the case group which was indicated by the white arrow and black arrow in the qPCR test, respectively. VD = vas deferens.

Figure 3

VD tuberculosis ultrasound findings (category 2 diffusely thickening VD) and pathological results. (A) The thickened wall and dilated lumen were indicated in the groin segment of the left VD in a 58-year-old man by the white arrow. (B) The right VD pelvic segment of the patient. Thickened VD wall was indicated by the white arrow, inside which the dilated lumen was revealed. (C) The thickened wall and dilated lumen was also indicated in the groin segment of the right VD by the white arrow. The CDFI picture shows abundant blood signals. (D) In the HE staining (×200) slides, the black arrow indicates the wall of the VD, white arrow indicates the granuloma. (E) In the acid-fast staining slide, black arrow indicates the coral-red positive bacillus. (F) The 2 lines represent the amplitution of the tuberculosis DNA fragments in the positive control group and the case group which was indicated by the white arrow and black arrow in the qPCR test, respectively. CDFI = color Doppler flow imaging, VD = vas deferens.

Figure 4

VD tuberculosis ultrasound findings (category 3, space-occupying lesions adjacent to vas deferens). (A) A male 56-year-old genital tuberculosis patient before antituberculosis treatment. The beginning of VD (the white arrow) was obviously enlarged as a spherical mass. Inside the mass, the echogenecity was heterogeneous. (B). In the same patient of Figure 4A, after treatments, the beginning of VD (indicated by the white arrow) was shrinked as rod-shaped mass and the echo was homogenous. VD = vas deferens.

Figure 5

Ultrasonographic appearance of the epididymis in tuberculosis of the male genital system. (A) The left epididymis of a male 56-year-old male genital tuberculosis patient was visualized (white arrow). (B) The left epididymis blood signal was abundant (white arrow). (C) The enlarged epididymis behind the left inhomogeneous testicle was indicated by the white arrow. (D) The abscess in the left scrotal wall was indicated by the white arrow.