What is the most likely cause for beaded appearance of fallopian tubes with clubbed ends of fimbriae on HSG?
Ans. a. Genital tuberculosis (Ref: Shaw's 16/e p111)Most likely cause for beaded appearance of fallopian tubes with clubbed ends of fimbriae on HSG is genital Tuberculosis." Tubal occlusion in tuberculosis is considered the most common sign observed on an HSG and occurs most commonly in the region of isthmus and ampulla. Multiple constrictions along the course offallopian tube can also form from scarring and give rise to 'beaded' appearance to the tubes. Scarring can also lead to a 'rigid pipe stem' appearance of the tubes."Hysterosalpingographic presentation of tubal TB vary from non-specific changes such as hydrosalpinx to specific- pattern such as "beaded tube", "golf club tube, "pipestem tube", "cobble stone tube" and the "leopard skin tube".Genital TuberculosisGenital tuberculosis is almost always a secondary infectionQMC primary sites: Lungs >Lymph nodes >AbdomenQMC Route of spread: HematogenousQSites of Genital TB% InvolvementTubes90-100%QUterus50-60%QOvaries20-30%QVagina & Vulva1-2%QPathology :MC site: Bilateral fallopian tubesQIn Fallopian tubes: MC affected part: Ampulla; MC encountered pathology is endosalpingitisQ2nd MC site of involvement: UterusQCornu of the uterus is MC affected as it is in continuation with the fallopian tube & infection descends from the tubesQClinical Features:MC age group: 20-30 years (28 years specifically)MC symptom: InfertilityQUterine TB can manifest in the form of:Ashermairs syndrome (destruction of the endometrial lining of uterine cavity with the formation of intrauterine synechiae or adhesions)QPyometra (pus-filled uterine cavity)If patient conceives spontaneously, ectopic pregnancy is the most likely outcome.Menstrual abnormalities: Hypomenorrhea or amenorrhea due to Asherman's syndrome & polymenorrhea menorrhagiaQDiagnosis:Hysterosalpingography in TBHSG is contraindicated in patients of genital TB as it can lead to reactivation or spreading of diseaseQ.If unknowingly HSG is done in patients of TB, characteristic findings are* Lead pipe appearance of tubeQ* Beaded appearance of tubeQ* HydrosalpinxQ* Corneal blockQ* Intravasation of dyeQ* Golf club tubeQ* Tobacco pouch appearance of the fimbrial end of tube Q* Uterus: Honeycomb appearance due toAsherman syndromeQEndometrial biopsy: Best time is 1-2 days before or 12 hours after onset of menses. In unmarried girls, menstrual blood can be collected within 12 hours of onset of menstruation.PCR done on endometrium or menstrual blood is more sensitive than microscopy & bacteriological culture.Treatment:Genital tuberculosis falls in category 1. The treatment is ATT for 6 months Surgery for restoration of fertility (corrective tuboplasty ) is contraindicated in genital TBQIVF after completion of ATT is the treatment of infertility.
Genital tuberculosis
Chlamydia
Neisseria gonorrhoea
Endometriosis
Pelvic Inflammatory Disease