Tubercular Salpingitis

Case contributed by Ashish Mohan Bhattarai
Diagnosis almost certain


Primary infertility since four years and history of foul smelling pervaginal discharge since one year

Patient Data

Age: 30 years
Gender: Female

Hysterosalpingography shows multiple constrictions and dilatation of ampulla and infundibulum of B/L fallopian tube giving beaded appearance in keeping with tubercular salpingitis.

There is also a well-circumscribed, oval filling defect noted in the endometrial cavity persistent in consecutive films in keeping with uterine fibroid.

Case Discussion

Tubercular salpingitis is one of the most common causes of primary infertility in low socio-economic countries. Diagnosis of genitourinary tuberculosis may be difficult as most of the cases are asymptomatic. Hysterosalpingography is the best identification tool to visualize the uterine and tubal pathologies like patency, filling defects, scarring, and other congenital abnormalities.

Genital tuberculosis has three major routes of infection, hematogenous, lymphatic, or direct contact from surrounding tissues. It most commonly affects the fallopian tubes (95-100%), followed by the endometrium (50-60%), ovaries (20-30%), cervix (5-15%), vulva/vagina (1%), and the myometrium (2.5%). The bilateral fallopian tubes are the initial focus of female genital tuberculosis. 
Hysterosalpingography can present tubal tuberculosis in many forms, such as hydrosalpinx to specific patterns such as beaded tube, golf club tube, pipestem tube, cobblestone tube, and the leopard skin tube.

In this case, we can appreciate the beaded tube-like lesion of tubercular salpingitis confirmed by laparoscopic biopsy and histopathologic examination.

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