Tuberculous pelvic inflammatory disease

Tuberculous pelvic inflammatory disease refers to pelvic inflammatory disease due to Mycobacterium tuberculosis.

Epidemiology

Genital tract involvement may be present in ~1.5% of cases of those affected with tuberculosis ⁴.

Pathology

Infection almost always results from spread from an extragenital source ¹, usually from a hematogenous source or less commonly, via lymphatic vessels or from the peritoneal cavity.

Location

In the vast majority of cases, it involves the Fallopian tubes: tubal tuberculosis ¹, Involvement is often bilateral ⁴.

Radiographic features

Hysterosalpingography (HSG)

• tubal involvement:
  • obstruction of the Fallopian tube in the zone of transition between the isthmus and the ampulla
  • multiple constrictions along the course of the Fallopian tube (resulting in a beaded appearance to the tube)
• endometrial involvement: features may vary; the spectrum according to one study was ²
  • normal uterine cavity: ~57% 
  • irregular cavity: ~18.5%
  • irregular filling defect: ~18.5%
  • uterine synechiae:  ~17%
  • shrunken cavity: ~3%
• adnexal involvement
  • they may be calcified lymph nodes or smaller, irregular calcifications in the adnexal area

CT

Tuberculous pelvic inflammatory disease may be associated with

• peritoneal involvement of tuberculosis (present in up to 50%) ⁶
  • complex ascites
  • thickened and nodular peritoneum
• lymphadenopathy
  • necrotic
  • calcified (chronic disease)

Treatment and prognosis

Complications

• infertility
• formation of tubo-ovarian abscesses
• tuberculous peritonitis: may be present in ~50% of cases ⁴

Differential diagnosis

For the hysterosalpingography appearance consider:

• salpingitis isthmica nodosa (SIN)
• Asherman syndrome: multiple adhesions