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. 2022 Oct-Dec;15(4):362-369.
doi: 10.4103/jhrs.jhrs_111_22. Epub 2022 Dec 30.

Hysterosalpingography Observations in Female Genital Tuberculosis with Infertility

Jai Bhagwan Sharma  1 , Supriya Kumari  1 , Parul Jaiswal  1 , Sona Dharmendra  1 , Smriti Hari  2 , Urvashi B Singh  2
Affiliations

Hysterosalpingography Observations in Female Genital Tuberculosis with Infertility

Jai Bhagwan Sharma et al. J Hum Reprod Sci. 2022 Oct-Dec.

Abstract

Background: Hysterosalpingography (HSG) is radiographic evaluation of uterine cavity and tubal patency.

Aims: The aim of this study was to evaluate the safety and utilisation of HSG in female genital tuberculosis (FGTB) with infertility.

Settings and design: The study was conducted in a tertiary referral centre of North India.

Materials and methods: It was a prospective study on 87 cases of FGTB with infertility. Diagnosis of FGTB was made by composite reference standard using the presence of acid-fast bacilli on microscopy/culture or positive GeneXpert, positive polymerase chain reaction or epithelioid granuloma on endometrial biopsy or definitive or probable findings on laparoscopy or hysteroscopy.

Statistical analysis used: Suitable statistical methods were used with STATA software version 12.0.

Results: HSG findings were normal in 49 (56.32%) cases. There were filling defects in 14 (16.09%), short and shrunken cavity in 4 (4.49%), intrauterine synechiae in 14 (16.09%), T-shaped cavity in 3 (3.44%) and deformed uterine cavity in 5 (5.74%) cases. Fallopian tube findings were hydrosalpinx in 12 (13.79%) and 11 (12.64%) cases, beading of tube in 4 (4.59%) and 2 (2.29%) cases, pipestem appearance in 2 (2.29%) cases each and Maltese cross appearance in 3 (3.44%) and 2 (2.29%) cases, respectively. Tubal blockage was seen in 69 (79.31%) and 67 (77.01%) cases being cornual block in 28 (32.18%) and 26 (29.88%) cases, mid-tubal block in 16 (18.39%) and 15 (17.24%) cases, multiple blocks in 10 (11.49%) and 12 (13.79%) cases and fimbrial block in 15 (17.24%) and 14 (16.09%) cases. None of the cases had flare-up of the disease after HSG in the current study.

Conclusion: HSG is a useful modality in FGTB with infertility.

Keywords: Extrapulmonary tuberculosis; female genital tuberculosis; hysterosalpingography; infertility.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
HSG showing right-sided beaded tube (single arrow) and left-sided hydrosalpinx (double arrow) in case of FGTB. HSG = Hysterosalpingography, FGTB = Female genital tuberculosis
Figure 2
Figure 2
HSG showing left-sided distal hydrosalpinx (arrow) with delayed spill with venous and lymphatic intravasation in case of FGTB. HSG = Hysterosalpingography, FGTB = Female genital tuberculosis
Figure 3
Figure 3
HSG showing right fimbrial dilatation (terminal hydrosalpinx) with loculated spill and left tubal cornual block with filling defect in the case of FGTB. HSG = Hysterosalpingography, FGTB = Female genital tuberculosis
Figure 4
Figure 4
HSG showing bilateral mid-tubal block with pipestem rigidity (arrow) in case of FGTB. HSG = Hysterosalpingography, FGTB = Female genital tuberculosis
Figure 5
Figure 5
HSG showing filling defect in uterine cavity with right-sided cornual block (arrow) in a case of FGTB. HSG = Hysterosalpingography, FGTB = Female genital tuberculosis
Figure 6
Figure 6
HSG showing small shrunken cavity with bilateral isthmic block in case of FGTB. HSG = Hysterosalpingography, FGTB = Female genital tuberculosis
Figure 7
Figure 7
HSG showing small filling defect in uterine cavity with bilateral fimbrial block (single arrow) with intravasation of dye in both ovarian veins up to abdomen (double arrow) in a case of FGTB. HSG = Hysterosalpingography, FGTB = Female genital tuberculosis
Appendix 1
Appendix 1
Flowchart algorithm using composite reference standard for diagnosis of female genital TB. TB: Tuberculosis, FGTB: Female genital tuberculosis, PCR: Polymerase chain reaction, CRS: Composite reference standard, USG: Ultrasound, CT: Computerised tomography, MRI: Magnetic resonance imaging, PET: Positron emission tomography, ATT: Anti-tubercular therapy
See this image and copyright information in PMC

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