Tobacco pouch appearance: HSG sign of tubercular salphingitis
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CLASSICS IN ABDOMINAL RADIOLOGY
Tobacco pouch appearance: HSG sign of tubercular salphingitis Surabhi Agarwal1 · Pragya Chaturvedi1 · Priyank Yadav2 · Hira Lal1,3 Received: 8 July 2020 / Revised: 11 September 2020 / Accepted: 21 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
The “tobacco pouch” appearance is a classic imaging sign seen on hysterosalpingogram (HSG) images in 25–50% of cases of genital tuberculosis (TB) [1]. It represents an enlarged and distended fallopian tube with recognizable everted fimbriae. A tobacco pouch is affixed with a drawstring for opening and closing the bag (Fig. 1). Genitourinary TB is caused by Mycobacterium tuberculosis and occurs secondary to hematogenous or lymphatic spread from an extragenital source, most commonly lung. It causes infertility in up to 17% of cases [2, 3]. In the majority of cases, fallopian tubes are involved bilaterally but not symmetrically [4]. In the active phase, the tubes develop caseous ulceration of mucosa and become dilated. As the
disease progresses to chronic phase, healing with fibrosis leads to obstruction at places (particularly isthmus and ampulla), while dilatation may persist at other places. When such obstruction occurs in distal ampulla, HSG shows terminal hydrosalpinx with distal conical narrowing and patent proximal tubal orifice resembling a closed tobacco pouch: the so-called tobacco pouch appearance (Fig. 2). The conical narrowing is due to ampullary obstruction and fimbrial eversion secondary to adhesions and the terminal hydrosalpinx represents disproportionate dilatation of the club-shaped ampullary end of fallopian tubes.
* Hira Lal [email protected] 1
Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow 226014, India
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Department of Urology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Raibareli Road, Lucknow 226014, India
3
Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Room No: 35, Raibareli Road, Lucknow, Uttar Pradesh 226014, India
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Fig. 1 A tobacco pouch resembling the appearance of fallopian tubes on HSG images in Fig. 2
Fig. 2 HSG image showing terminal hydrosalpinx with distal conical narrowing in a patient with genital tuberculosis
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Abdominal Radiology
Abdominal Radiology Funding None.
References
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1. Daly JW, Monif GRG: Mycobacteria. In Monif GRG (ed): Infectious Diseases in Obstetrics and Gynaecology. p 301, 2nd ed. Philadelphia, Harper & Row, 1982. 2. Golden MP, Vikram HR. Extrapulmonary tuberculosis: An overview. Am Fam Physician. 2005;72:1761–8. 3. Schaefer G: Female genital tuberculosis. Clin Obstet Gynecol 19:223, 1976 4. Nogales-Ortiz F, Tarancon I, Nogales FF. The pathology of female genital tuberculosis. Obstet Gynecol 1979;53:422–8.
Conflict of interest The authors declare that they have no conflict of interest. Research involving human participants and/or animals This article
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