Sonographic features of tuberculous endometritis

Abstract

Female genital tuberculosis is an uncommon condition. We have recently performed an ultrasound examination on an unexpected case and we present the sonographic findings. CASE REPORTA 59-year-old female was admitted to the hospital because of congestive heart failure. She also had diabetes mellitus and rheumatoid arthritis. After her heart failure and diabetes were controlled, urinary analysis revealed microscopic hematuria. An intravenous urogram was performed and demonstrated a large indentation on the right side of the dome of the bladder. She was referred for pelvic sonography .The sonogram demonstrated a well-defined mass indenting the urinary bladder. There was considerable sound transmission but no posterior enhancement. This mass extended from the midline to the right side. The vagina could be identified, but the junction with the mass was obscured by refractive shadowing from the top of the bladder. The uterus and the ovaries could not be identified with certainty (Figs. 1-3). As these organs might be atrophic and difficult to be imaged, a definite distinction between a uterine or ovarian mass could not be made confidently.The patient gave no history of vaginal discharge nor postmenopausal bleeding. The clinical impression was that this was more likely to be an ovarian mass. Laparoscopy was not contemplated because of previous operations. At laparotomy, extensive dense adhesion was encountered making it difficult to ascertain the origin of the mass. FIGURE 1. Longitudinal scan midline: B = urinary bladder; U = uterus = mass; and X = cervix.

Magnetic Resonance Imaging Findings of Tuberculous Endometritis

“…[2][3][4]6,8,9 There are few reports of primary cervical disease in which the sexual partner has been thought to be the source of infection. 2 Approximately 50% to 60% of women with genital tuberculosis develop tuberculous endometritis.…”

“…3 Previous imaging reports demonstrated only limited information about tuberculous endometritis. 2,6,7 According to Lee et al, 6 the findings of the tuberculous pyometra by transperitoneal ultrasound examination are nonspecific and mimic degenerated fibroid, hematometrocolpos, uterine cancer, lymphoma, carcinosarcoma, and adnexal tumor. Anderson 2 reported that the uterine cavity is classically shriveled and deformed, with associated intrauterine adhesions and lymphatic intravasation on hysterosalpingography.…”

“…1 Several previous reports have discussed cytologic features and critical factors of tuberculous endometritis, 2-5 but few have included radiologic imaging features. Although there have been an ultrasound report 6 and hysterosalpingography reports 2,7 in the past, to our knowledge, the magnetic resonance (MR) imaging features of tuberculous endometritis have not previously been described.…”