Computed Tomographic Findings in Female Genital Tuberculosis Tubo-Ovarian Masses

Abstract Female genital tuberculosis (FGTB) is a common cause of infertility in developing countries. It can manifest as menstrual disturbances, infertility and pelvic masses. Objective To evaluate the role of computed tomography in diagnosis of female genital tuberculosis with tubo-ovarian (adnexal) masses. Methods It was a prospective study over a four year period (July 2015 to August 2019) in a tertiary referral centre over 33 patients presenting with tuberculosis and tubo ovarian masses only. 75 total cases of FGTB diagnosed on composite reference standard (evaluation of AFB bacilli in microscopy or culture or endometrial biopsy, gene expert, epitheloid granulomas on endometrial biopsy or definitive or possible findings of FGTB on laparoscopy). Detailed history taken, clinical examination, baseline investigations and endometrial biopsy were done in all cases. Computed tomography was performed in women presenting with infertility, tubo ovarian masses on clinical examination and laboratory investigations. A total of 33 cases were evaluated. Results Mean age, body mass index, parity and history of TB contact were 27.5± 4.2 year, 22.7± 3.6 kg/m2, 0.27± 0.13 and 44.4% respectively. Infertility was primary in 72.72% and secondary in 27.23%. Case wise mean duration being 5.8 years, menstrual dysfunction was seen in 45.45% cases. Abdominal discomfort with pain and lump were seen in all 33 (100%) cases. Abdominal lumps were felt in 4(12.12%) cases while adnexal mass was seen in all 33 (100%) cases being unilateral in 18(54.54%) and bilateral in 15(45.45%). Mean ESR was 33.4mm in first hour while mean leucocyte count was 6128± 2854 per cubic mm. Infectious mantoux test (>10mm) was seen in 14 (42.82%) cases while abnormal X ray chest was seen in 9(27.27%) cases. Diagnosis of FGTB was made by positive AFB n microscopy or culture of endometrial biopsy in 5(15.15%) cases, positive gene expert in 6(18.18%) cases, positive polymerase chain reaction in 32(96.96%) cases, epitheloid granulomas on histopathology of endometrial biopsy in 7(21.21%) cases, definitive findings of tuberculosis in 15(45.45%) cases and a possible findings of tuberculosis inn 18(54.54%) cases. Various CT findings were pelvic mass(100%), unilateral pelvic mass in 18(54.54%), bilateral pelvic mass in 15(45.45%), cystic mass(24.2%), solid mass(21.2%), mixed mass(54.54%), mass showing multilocular caseous necrotic enhancements(12.12%), ascites(42.4%), thickening and enhancement of peritoneum in 14(42.42%), nodules in 24.2%, smooth in 18.8%, pelvic adhesion in 6(18.18%), lymphadenopathy in 8(24.3%) with calcifications(9.09%) and central necrosis(52.5%). Other CT findings were thickening and enhancement of bowel wall(12.12%), hepatic TB(3.03%), splenic TB(3.03%), omental thickening (9.09%) and omental calcification(3.03%) cases. Conclusion Computed tomography appears to be a useful diagnostic modality in diagnosis of tuberculosis tubo ovarian masses and may help avoid unnecessary surgery.