Sonographic features of tuberculous peritonitis with female genital tract tuberculosis

Our aim was to illustrate the sonographic features of tuberculous peritonitis with female genital tract tuberculosis in an attempt to facilitate the recognition of the disorder preoperatively. Transabdominal and transvaginal sonographic features and the findings from laparotomy/laparoscopy, endometrial biopsy and microbiology were reviewed and compared in 15 patients with tuberculous peritonitis with female genital tract tuberculosis. Of the 15 patients, 12 had wet tuberculosis and three had dry (adhesive) tuberculosis. Sonographic features of wet tuberculosis were categorized as follows: septated ascites (ten patients), particulate ascites (two patients), loculated fluid (two patients), thickened peritoneum (eight patients), thickened omentum (eight patients), adnexal mass (11 patients), adhesions (seven patients) and endometrial involvement (five patients). Adnexal masses, adhesions and loculated fluid were found to be present in the dry type. When sonographic findings were compared with those of laparotomy and/or laparoscopy and/or endometrial biopsy, ultrasound was able to identify aspects of tuberculosis infection as follows: ascites/loculated fluid, 13/13 (100%); adnexal mass, 12/13 (93%); peritoneal thickening, 9/13 (69%); omental thickening, 8/13 (61%); and endometrial involvement, 5/6 (83%). We conclude that awareness of the sonographic changes associated with tuberculosis infection may improve diagnostic accuracy, and avoid clinical mismanagement and surgical explorations in the wet type of tuberculosis.