Genital tuberculosis (HSG)

Genital Tuberculosis – Hysterosalpingography

HSG

Genital tuberculosis is a chronic infection of the female genital tract caused by Mycobacterium tuberculosis. It is a significant cause of tubal factor infertility, especially in endemic regions. Both fallopian tubes are commonly affected, resulting in fibrosis, strictures, and luminal obliteration. On hysterosalpingography (HSG), characteristic features include rigid tubes, multiple strictures, beaded or pipe-stem appearance, and absent or delayed peritoneal spill.

Fig-1

Fig. 1—Hysterosalpingogram showing tubal irregularities consistent with genital tuberculosis. Beaded or rigid tubes with segmental strictures are noted, with absent peritoneal spill (arrows).

Findings: Uterine cavity may be normal or show irregularity due to endometrial involvement. Both fallopian tubes demonstrate alternating dilatation and constriction. Distal obstruction is common, and free peritoneal contrast is often absent.

Conclusion: HSG features are consistent with genital tuberculosis.

Patient Symptoms

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

Procedure (Hysterosalpingography)

HSG is performed during the early proliferative phase. 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. Approximately 5–8 mL is injected slowly in the lithotomy position under fluoroscopic guidance.

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

Avoid high injection pressure to prevent tubal rupture. Active pelvic infection should be treated prior to 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.