Tuberculosis of the fallopian tube is one of the most common sites of tuberculous pelvic inflammatory disease.
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Clinical presentation
Many patients may be asymptomatic, with the disease being discovered during the workup for infertility. Signs and symptoms are often vague and can include acute or chronic pain, infertility, and vaginal bleeding.
Pathology
Like pelvic tuberculosis, infection almost always results from spread from an extragenital source, usually hematogenous or less commonly via lymphatic vessels or from the peritoneal cavity.
Location
Both tubes are usually affected.
Radiographic features
Plain radiograph
May show calcification of the fallopian tubes in a small proportion of patients. Tubal calcification can take the form of linear streaks, which lie in the course of the fallopian tube or appear as faint or dense tiny nodules.
Hysterosalpingography (HSG)
On HSG, tubal tuberculous caseous ulcerations will lead to shaggy, irregular, beaded and diverticular appearance of the tubal lumen.
Diverticular outpouchings involving the ampullary portion of the tube may give it a "tufted" or "rosette like" appearance. If the diverticular outpouhcings involved the isthmic portion of the tube, it will be similar to salpingitis isthmica nodosa (SIN), yet it could be differentiated by the large, asymmetric and bizzare appearance of the diverticulae in TB salpingits and the involvement of any part of the tube not just the isthmus.6
Multiple Dissemination of contrast in an irregular manner may give it a "cotton-wool plug" appearance 6.
Multiple constrictions along the course of the Fallopian tube can also form from scarring and give rise to ‘‘beaded’’ appearance to the tubes (usually seen on an HSG).
Tubal occlusion in tuberculosis is considered a less common sign and occurs most commonly in the region of isthmus and ampulla 5.
Distal occlusion with dilatation at the ampulla will give the "golf club" appearance 6
The whole tube could be encased by extensive connective tissue scarring leading subsequently to a "straight rigid pipe stem" appearance without normal tortuosity 6
MRI
Tuberculous salpingitis without blockage can appear as a thick walled tortuous structure with vivid enhancement.
Differential diagnosis
On a hysterosalpingogram consider:
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