Tuberculous pelvic inflammatory disease refers to pelvic inflammatory disease due to Mycobacterium tuberculosis.
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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
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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)
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endometrial involvement: features may vary; the spectrum according to one study was 2
normal uterine cavity: ~57%
irregular cavity: ~19%
irregular filling defect: ~19%
uterine synechiae: ~17%
shrunken cavity: ~3%
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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
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peritoneal involvement of tuberculosis (present in up to 50%) 6
complex ascites
thickened and nodular peritoneum
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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:
Asherman syndrome: multiple adhesions