32yr. Nulipara with cyst of 32mm. 34mm. In Rt ovary, Can HSG be possible. If not, suggest other test

what management will be needed for this person with TSH level 4.95

HSG FINDINGS IN GENITAL KOCHS : Female genital tuberculosis is a major cause of tubal obstruction leading to infertility , especially in developing countries. Genital tuberculosis is difficult to diagnose. DEFINITIVE DIAGNOSIS OF GENITAL TUBERCULOSIS IS MADE BY 1 ) POSITIVE MYCOBACTERIUM CULTURE IN ENDOMETRIAL TISSUE . 2 ) HISTOLOGICAL DIAGNOSIS OF TUBERCLES / GRANULOMAS . HYSTEROSALPINGOGRAM IS THE GOLD STANDARD IMAGING PROCEDURE IN EVALUATING THE INTERNAL ARCHITECTURE OF THE FEMALE GENITAL TRACT. The radiographic features of genital tuberculosis is described in two parts 1 ) PART I / SPECIFIC FEATURES : Related to tubes . BEADED TUBE. PIPESTEM TUBE . GOLF CLUB TUBE . COBBLE STONE TUBE . LEOPARD SKIN TUBE . 2 ) PART II : Related to endometrium. This describes the adverse effects of tuberculosis on the structure of endometrium. DWARFED UTERUS WITH LYMPHATIC INTRAVASATION AND OCCLUDED TUBES "T" SHAPED UTERUS . PSEUDOUNICORNUATE UTERUS. COLLAR STUD ABSCESS. HSG FINDINGS : 1 ) CALCIFICATION OF FALLOPIAN TUBES ,OVARY .Tubal calcification is usually seen in the form of small linear streaks in the course of tubes. 2 ) HYDROSALPINX : HSG shows dilated fallopian tube filed with contrast and absence of free spillage of dye. 3 ) TUBAL OCCLUSION : Distal tubal occlusion causes hydrosalpinx and in proximal tubal occlusion, dye fails to enter the tubes and therefore tubes are not visualized. 4 ) TUFTED LIKE APPEARANCE / ROSETTE LIKE APPEARANCE : Caseous ulceration of tubal mucosa creates an irregular, ragged or diverticular appearance on the contour of tubal lumen in HSG These diverticular cavities surrounding the ampulla produced by caseous ulceration gives the tubal outline "tufted like appearance / rosette like appearance. 5)TB-SIN : TUBERCULOSIS-SALPINGITIS ISTHMICA NODOSA : Penetration of contrast medium between the mucosal folds due to ulceration of tubal mucosa causes diverticular - like outpouchings. 6 ) COTTON WOOL PLUG APPEARANCE: Distribution of contrast medium in a reticular pattern produces cotton wool plug appearance. 7 ) SAW TOOTHED APPEARANCE: when the tubal lumen is filled with putty like caseous material, the HSG outline is irregular with pockets or Laguna giving a saw toothed appearance. 8 ) BEADED TUBE : Multiple constrictions along the fallopian tubes gives a beaded appearance. 9 ) PIPE STEM TUBE : Absence of normal tortuosity and curved / straight pipe like rigid appearance in fibrotic stage of tubercular salpingitis causes pipe stem appearance. 10 ) LEOPARD SKIN TUBE : Multiple rounded filling defects following intra luminal granulomas formation within the hydrosalpinx gives leopard skin appearance . 11 ) GOLF CLUB TUBE : Sacculation of tubes in distal portion with an associated hydrosalpinx gives a golf club like appearance. 12 ) COBBLE STONE APPEARANCE : Intra luminal scarring gives rise to cobble stone pattern which indicates intra luminal adhesions . 13 ) TOBACCO POUCH APPEARANCE : Eversion of fimbria secondary to adhesions with a patent orifice produces tobacco pouch appearance.

pt.31/m c/o dry cough since 1 month.. CXRay provides fo comments..

This is an x-ray chest PA view from a 26-year-old boy who presented with a left scrotal swelling for 6 months and low grade fever for 2 months. On examination, built and nourishment is below average, afebrile. No lymphadenopathy, clubbing. Mild pallor present. A swelling of size 2 X 3 cm is found in left scrotum arising from left spermatic cord, non tender with no local rise of temperature. Rest of the systems WNL. The case is open for discussion.

A 30-year-old woman with normal sexual life was infertile for 9 years after induction of labor in her 15th week of pregnancy. The abortion procedure was unclear, but the patient felt no unusual discomfort at that time. The routine B-ultrasound diagnosed intrauterine foreign bodies. What can be the possible cause?