Question
A couple reports to the outpatient department with concerns about infertility. The husband’s semen analysis results are within normal ranges. The wife experiences excessive menstrual bleeding, and her diagnostic imaging, specifically a hysterosalpingogram, shows distal tube dilatation with a characteristic “tobacco pouch appearance.” Based on these findings, what is the most likely diagnosis for the wife’s condition?
| A. |
Tubal salpingitis |
| B. |
Tubal endometriosis |
| C. |
Tubal polyp |
| D. |
Tubal spasm |
Show Answer
|
Correct Answer » A Explanation |
 |
- “Tobacco pouch appearance” on HSG is a classic feature of chronic tubal salpingitis, especially tubercular salpingitis.
- Chronic inflammation causes:
- Distal tubal obstruction
- Hydrosalpinx
- Dilated ampullary end
- Eversion and clubbing of fimbriae
- These changes produce the characteristic tobacco pouch appearance.
- Tubal damage leads to infertility despite normal semen analysis in the husband.
Why Other Options are Incorrect
B. Tubal endometriosis
- Endometriosis can cause infertility and adhesions.
- Typical findings include pelvic adhesions, chocolate cysts, and distorted pelvic anatomy.
- Tobacco pouch appearance is not characteristic.
C. Tubal polyp
- Tubal polyps produce intraluminal filling defects on HSG.
- They do not cause distal tubal dilatation with fimbrial eversion.
D. Tubal spasm
- Tubal spasm causes temporary cornual blockage during HSG.
- It is transient and does not produce chronic structural changes like hydrosalpinx or tobacco pouch appearance.