Tuberculous salpingitis (HSG)

Tuberculous Salpingitis – Hysterosalpingography

Tuberculous salpingitis is a form of genital tuberculosis and represents one of the most common causes of tubal factor infertility in endemic regions. The fallopian tubes are usually affected bilaterally, leading to fibrosis, strictures, and obliteration of the tubal lumen. On hysterosalpingography (HSG), characteristic features include tubal beading, rigid “pipe-stem” appearance, multiple strictures, and absent peritoneal spill.

Fig-1

Fig. 1—Hysterosalpingogram showing tuberculous salpingitis. The fallopian tubes appear rigid with multiple constrictions and segmental narrowing, producing a beaded appearance, with no free peritoneal spill (arrows).

Findings: The uterine cavity may be normal or show irregularity depending on endometrial involvement. Both fallopian tubes demonstrate irregular outlines with alternating dilatation and narrowing, distal obstruction, and absence of free intraperitoneal contrast spill.

Conclusion: Hysterosalpingographic features are consistent with tuberculous salpingitis.

Patient Symptoms

Patients commonly present with primary or secondary infertility. Other symptoms may include chronic pelvic pain, menstrual irregularities, low-grade fever, weight loss, or a past history of tuberculosis.

Procedure (Hysterosalpingography)

HSG is performed during the early proliferative phase of the menstrual cycle. Gentle, low-pressure contrast injection is essential due to friable and fibrotic tubal walls.

Contrast Medium & Administration

A water-soluble iodinated contrast medium such as Iohexol or Iopamidol (300–350 mg iodine/mL) is used. The patient is positioned in the lithotomy position, and approximately 5–8 mL of contrast is injected slowly under fluoroscopic control.

Instruments Used

• Sterile vaginal speculum (Cusco’s or Sims’)
• Leech–Wilkinson cannula
• Rubin cannula
• Balloon HSG catheter
• 10–20 mL sterile Luer-lock syringe
• Sterile connecting tubing
• Antiseptic solution
• Fluoroscopy unit

Safety Considerations

Excessive injection pressure should be avoided to prevent tubal rupture or intravasation. Active pelvic infection is a contraindication. Adequate infection screening is recommended before the procedure.

Related Conditions

Differential diagnoses include chronic pelvic inflammatory disease, hydrosalpinx, salpingitis isthmica nodosa, post-surgical tubal scarring, and tubo-ovarian adhesions. Correlation with ultrasound, MRI, and microbiological tests is advised.

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Declaration

This case is presented for academic and educational purposes only. Patient confidentiality has been preserved.