Ahmadi Firoozeh, Zafarani Fatemeh, Shahrzad Gholam Shahrzad
Department of Reproductive Imaging at Reproductive Biomedicine Research Center, Royan Institute for Reproductive Biomedicine, ACECR, Tehran, Iran.
Int J Fertil Steril. 2014 Apr;8(1):13-20. Epub 2014 Mar 9.
Female genital tuberculosis remains as a major cause of tubal obstruction leading to infertility, especially in developing countries. The global prevalence of genital tuberculosis has increased during the past two decades due to increasing acquired immunodeficiency syndrome. Genital tuberculosis (TB) is commonly asymptomatic and it is diagnosed during infertility investigations. Despite of recent advances in imaging tools such as computed tomography (CT) scan, magnetic resonance imaging (MRI) and ultrasongraphy, hysterosalpinography has been considered as the standard screening test for evaluation of tubal infertility and as a valuable tool for diagnosis of female genital tuberculosis. Tuberculosis gives rise to various appearances on hysterosalpingography (HSG) from non-specific changes to specific findings. The present pictorial review illustrates and describes specific and non-specific radiographic features of female genital tuberculosis in two parts. Part I presents specific findings of tuberculosis related to tubes such as "beaded tube", "golf club tube", "pipestem tube", "cobble stone tube" and the "leopard skin tube". Part II will describe adverse effects of tuberculosis on structure of endometrium and radiological specific findings, such as "T-shaped" tuberculosis uterus, "pseudo-unicornuate "uterus, "collar-stud abscess" and "dwarfed" uterus with lymphatic intravasation and occluded tubes which have not been encountered in the majority of non-tuberculosis cases.
女性生殖器结核仍然是导致输卵管阻塞进而引起不孕的主要原因,在发展中国家尤其如此。在过去二十年中,由于获得性免疫缺陷综合征病例增加,生殖器结核的全球患病率有所上升。生殖器结核通常没有症状,常在不孕症检查时被诊断出来。尽管计算机断层扫描(CT)、磁共振成像(MRI)和超声等成像工具近年来取得了进展,但子宫输卵管造影术一直被视为评估输卵管性不孕的标准筛查试验,也是诊断女性生殖器结核的重要工具。结核在子宫输卵管造影(HSG)上会呈现出各种表现,从非特异性改变到特异性表现。本图片综述分两部分阐述和描述女性生殖器结核的特异性和非特异性影像学特征。第一部分展示与输卵管相关的结核特异性表现,如“串珠样输卵管”“高尔夫球杆样输卵管”“烟斗柄样输卵管”“鹅卵石样输卵管”和“豹皮样输卵管”。第二部分将描述结核对子宫内膜结构的不良影响以及放射学特异性表现,如“T形”结核子宫、“假单角”子宫、“串珠样脓肿”和伴有淋巴管内渗及输卵管闭塞的“矮小”子宫,这些情况在大多数非结核病例中并不常见。