What are the ultrasound findings of tuberculosis of the cervix?

Ultrasound Findings of Tuberculosis of the Cervix

Tuberculosis of the cervix presents with characteristic ultrasound findings that can help distinguish it from cervical malignancy, though histopathological confirmation is essential for definitive diagnosis.

Key Ultrasound Features

• Hypoechoic lesions with evidence of necrosis are the most common finding in cervical tuberculosis, similar to what is observed in tuberculous lymphadenitis 1
• Heterogeneous echogenicity within the cervical tissue is more likely to be present in tuberculosis compared to other conditions 2
• Coagulation necrosis visible on ultrasound examination is a characteristic finding that may help differentiate tuberculosis from other cervical pathologies 2
• Sharp margins are commonly observed (present in approximately 70% of tuberculous lesions in studies of tuberculous lymphadenitis) 1

Distinguishing Features from Cervical Cancer

• Tuberculous cervical lesions may appear as hypertrophic, ulcerative, or exophytic masses that can mimic cervical cancer on clinical examination and basic imaging 3, 4
• While both conditions can present with irregular cervical contours on ultrasound, tuberculous lesions more commonly show:
  • Evidence of central necrosis 1
  • Multilocular central low-density areas when complementary CT imaging is performed 1
  • Calcifications may be present in approximately 30% of cases 1

Advanced Imaging Considerations

• Transvaginal ultrasound is preferred for detailed evaluation of cervical lesions, as it provides better visualization of the cervical architecture compared to transabdominal approaches 2
• When cervical abnormalities are identified but not adequately visualized on transabdominal ultrasound, transvaginal evaluation is recommended 2
• Complementary CT imaging may provide additional information, showing:
  • Central low-density areas (seen in approximately 59% of tuberculous lesions) 1
  • Large confluent low-density areas (in about 26% of cases) 1
  • Multilocular central low-density areas (in approximately 15% of cases) 1

Clinical Correlation with Ultrasound Findings

• Ultrasound findings should be correlated with clinical presentation, which may include:
  • Serosanguineous vaginal discharge 3
  • Irregular firm cervix with contact bleeding 3
  • Infertility and menstrual irregularities in some cases 5
  • Postcoital bleeding 5

Diagnostic Approach

• Ultrasound helps in better localization of the site for biopsy/FNAC procedure with high diagnostic yield 1
• Histopathological examination of endocervical curettings or cervical biopsy is essential for definitive diagnosis, as ultrasound findings alone cannot confirm tuberculosis 5, 3
• Bacteriological or histopathological confirmation is necessary before initiating anti-tuberculosis treatment 1

Pitfalls and Limitations

• Ultrasound findings of cervical tuberculosis can be easily mistaken for cervical cancer, leading to potential misdiagnosis 3, 4
• The rarity of cervical tuberculosis (accounting for only 0.1-0.65% of all tuberculosis cases) makes it a diagnosis that is often not initially considered 3
• Relying solely on ultrasound findings without histopathological confirmation can lead to inappropriate management 5, 4

Remember that tuberculosis of the cervix should always be considered in the differential diagnosis when cervical malignancy is initially suspected, especially in regions with high tuberculosis prevalence 4.