According to our data from 1992 to 2016 , we have encountered some specific hysteroscopic markers which are common to cases of endometrial TB:
I) Bizzare endometrial character: where the endometrium loses its color, glands and starts to look dirty, pale, white powdery nibbled, and has flimsy adhesions.
II) Granulomas or tubercles: They appear as small pale white irregular objects either on the endometrium directly or attached to flimsy adhesion bands. The tubercles vary in size.
III) Adhesions: From flimsy adhesions to moderate to severe adhesion bands, and often when looked closely these adhesions have tubercles /granulomas that look like whitish colored irregular deposits that are attached on the adhesions. It is very important therefore to start doing hysteroscopy at very low flow rates so that the deposits do not get washed away with continuous fluid irrigation.
IV) Tubal ostia: Tubal ostia are commonly involved in endometrial TB. The minor endosalpigean folds are scarred, white, pale and usually devoid of the longitudionally arranged vascularity. The ostia usually do not show the normal opening and closing physiological motion at lower intrauterine pressures. Flimsy large adhesion bands may be seen surrounding the ostia. Sometimes the ostia are completely hidden behind adhesions. Flimsy adhesions can also be seen in the intramural part of the ostia.
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Dr Alka is a great hysteroscopic surgeon….. great work