Predictability of Female Genital Tuberculosis by Hysterosalpingography by Biscuit350

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  Predictability of Female Genital
  Tuberculosis by
              Presentation by
       Dr.Narayan M.Patel
           Professor Emeritus, ob/gyn.
     N.H.L.muni.medical collage,Ahmedabad
       Mahalaxmi institute of medical
       teaching3,shantiniketan park,
     Ahmedabad-380014 (INDIA)               Normal look of tubes at H.S.G Pl.note       wavy outline of tubes spill on both side

Rigid pipe line tubes of proved kochs        The specimen after hysterectomy
                                                                              2 lead pipe with intravastion         Both tubes are lead pipe type

 Tubes straight + Typical terminal    Both tube eroded looking. Inner
 ends Looking like sperm head         lining of uterine cavity moth eaten appea.
Bil. cornual block & intravastion             Bil. Rogid pipeline tubes with
Of dye into vessels & lymphatics.             Intravasation of contrast.

                                            Bil.Cornual block with intra
 Bilateral cornual block & Intravasation.   myometrial intravasation (blue Ut.)
Intravasation of contrast in to tubal
musculature-? Salpingitis isthamica nodosa     Same tubes after removal

                                                Same tubes after removal
Severe form of ?Salpingitis isthamica nodosa
Bil. T.O.masses even after AKT for 1 year Hencec Bil.Salpingo-oopharectomy done.
had repeated attacks of intesti. obstruction

Bil hydrosalpingx. AKT given for 2 yr.   Same Pt.developed fibroid & hence Hyst.
•The appearance of
Koch’s tubes is similar
to bilateral tubal ligation
         John Richmond

• It looks like that of a
  Sperm head
              Narayan Patel            Unicornuat Ut. Spearm head appear. of
                                       terminal end of tube. Dilated cervicla canal

                                             Unicornuate Ut. Intravation of dye into
                                             myometrium and vesselles.

Previous pt. on injecting more dye.   Intravastion of dye into myometriums and
intravasation into myome. & lympatics lympatics and left terminal hydrosalpingx
Unicornuate Ut. Intravation of dye into   Intravastion of dye into myometriums and
myometrium and vesselles.            .    lympatic and terminal hydrosalpingx

                                                Green berg
                                                   has described it as
                                                    Tobacco- pouch or
                                                       Mail puoch
                                                     appearance of the
Appearance similar to bil.tubal ligation
                                                   fimbrial extremity.
Elongation and dilatation of cervical canal
Left tube appears as if tubectomy done  Left tubes -as if tubectomy is done
Also described as look of a sperm
head                                 . Beaded appearance at HSG typical- of kochs

Appearance similar to bil.tubal ligation    Appearance similar to bil.tubal ligation
Elongation and dilatation of cervical canal Elongation and dilatation of cervical canal
 Bilateral terninal hydrosalpingx                Left terminal hydro salpingx and right shows nodularity         .        cornual block

Left terminal hydrosalpingx,filling defect in
left tube, thich but patent              Elongation & crypts in cervical canal
Both terminal ends of tubes dilated   Both terminal ends of tubes dilated

Beaded appearance more on left side   Beaded appearance more on left side
Bil. Cornual block,cervical dilatation   Dwarfed Ut. Bil. Cornual block

Deformed Ut. It is not bicornuate UT.     Expansion and elongation Cervix
Following are radiological H.S.G. features
vary typical of genital tuberculosis
(1) Rigid pipe-stem tubes
(2) A clubbed ampula with retort shaped
    hydrosalpings. Spearm head appearance of
    terminal end of the tube
(3) Vascular or lymphatic intravasation of contrast.
(5) Small shrunken uterine cavity with filling defects
(6) long and dilated Cervical canal.& dye in cervical
(6) Bilateral Cornual block,
(7) Punctate opacification of crypts
       and diverticula's in lumen of tubes
• It is always better to perform H.S.G.
     with image Intensifier facility. Always use
     water soluble contrast.
•    I prefer Rubins’s canula
•   Always take minimum 2 x-rays.
•   As per Mishel’s text book of infertility, the
     most diagnostic study in a suspected case of genital
    tuberculosis is H.S.G.
•   H.S.G. which is properly performed and
      interpreted, can be of great value in the
       diagnosis of genital tuberculosis

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