To make \(\frac{9}{x^2} + 4y^2\) a perfect square, we need to find a term that when added will complete the square. The terms that need to be squared are:
\[
\sqrt{\frac{9}{x^2}} = \frac{3}{x}, \quad \sqrt{4y^2} = 2y
\]
So, to complete the square, we add:
\[
2 \cdot \left(\frac{3}{x} \cdot 2y\right) = \frac{12xy}{x}
\]
Thus, the correct answer is \(12x\).