MRI presentation of female genital tuberculosis: A case report

Objective - To present a rare case of female genital tuberculosis and its appearance on magnetic resonance imaging. Case report - A sixteen year old girl, presenting with appetite and weight loss, pelvic pain, headache, shortness of breath and secondary amenorrhea, was admitted to hospital with a suspected ovarian tumor. Clinical examination, laboratory analysis and radiological procedures were performed. Chest X-ray showed minimal pleural effusion on the left hand side. Voiding cystourethrography and intravenous urography were without abnormalities. Abdominal and pelvic ultrasound examination revealed the presence of an ovarian mass and ascites. Abdominal MRI showed mesenteric lymphadenomegaly, ascites with peritoneal nodular implants that showed diffusion restriction and post-contrast enhancement. Pelvic MRI showed heterogeneous masses involving both ovaries, free fluid in the cul-de-sac, nodular peritoneal implants with diffusion restriction and pathological post-contrast enhancement. Cytological analysis of the peritoneal fluid was undertaken. Laparoscopy and pathohistological analysis of the peritoneal specimen obtained were performed. Genital tuberculosis was confirmed. Conclusion - In this case it is stressed that even though MRI is the most sensitive diagnostic procedure, it is not sufficiently specific. The correct diagnosis was established by pathohistological examination. Adequate diagnosis and treatment are essential because the untreated disease causes severe morbidity, including sterility.