In genital tuberculosis, the characteristic finding on hysterosalpingography (HSG) that is virtually pathognomonic of tuberculous salpingitis is:

• A 'Pipestem' tubes — rigid, beaded fallopian tubes with terminal occlusion on contrast study ✓
• B 'Hockey stick' deformity of the intramural fallopian tube due to cornual block
• C 'Lead pipe' uterus — loss of normal uterine cavity architecture with synechiae
• D Bilateral hydrosalpinx with tortuous tubes and free peritoneal spill of contrast

Explanation

Tuberculous salpingitis on HSG shows the characteristic 'pipestem' or 'lead pipe' appearance: the tubes appear rigid, non-peristaltic, and beaded with terminal ampullary dilatation and a characteristic 'golf club' or 'lotus flower' terminal occlusion pattern. The rigidity is due to extensive intraluminal fibrosis and calcification. Other classical findings include 'golf club tube' (ampullary dilatation), calcified adnexal masses, and endometrial synechiae (Asherman's in severe cases). The 'hockey stick' deformity refers to obstructed tubes due to other causes; bilateral hydrosalpinx with free spill suggests non-tuberculous salpingitis.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.