Fitz-Hugh-Curtis syndrome
Fitz-Hugh-Curtis syndrome (FHCS), or perihepatitis, is the inflammation of the liver capsule and overlying pertioneum associated with adhesion formation without the involvement of the hepatic parenchyma. It is a chronic complication of pelvic inflammatory disease (PID).
Epidemiology
The prevalence in adults with mild to moderate pelvic inflammatory disease (gonorrhea) may approximate 4% . The prevalence may be higher in genital tuberculosis . It most commonly occurs in women of childbearing age; however, there have been rare cases reported in males .
Clinical presentation
Patients often present with a new-onset right upper quadrant or pleuritic chest pain on a background of pelvic inflammatory disease.
Pathology
It is thought to result from the direct intraperitoneal spread of infection towards the perihepatic region from initial pelvic inflammation/infection.
Diagnosis may be confirmed by the presence of Neisseria gonorrhea or Chlamydia trachomatis in fluid from the peritoneal cavity. Trichomonas vaginalis, Ureaplasma urealyticum and Mycoplasma hominis may also cause Fitz-Hugh-Curtis syndrome .
It has been demonstrated to occur in genital tuberculosis as well, and Mycobacterium tuberculosis may even be the dominating etiologic agent in endemic areas of developing countries .
Radiographic features
CT
Shows inflammatory changes in both pelvic and perihepatic regions.
Pelvic findings:
- may show a tubo-ovarian abscess
- pyosalpinx
- fluid collection in the pelvis
Perihepatic findings:
- can show inflammatory stranding and fluid along the right paracolic gutter as well as the perihepatic region
- often shows hepatic capsular enhancement
- gall bladder wall thickening
- pericholecystic inflammatory change
- transient hepatic perfusional abnormalities
History and etymology
The syndrome was originally described by Arthur H Curtis in 1930 and Thomas Fitz-Hugh Jr in 1934.
Differential diagnosis
Imaging differential considerations include:
- peritoneal carcinomatosis: shows more peritoneal nodularity and a solid component, overt pelvic malignancy on imaging and has a different clinical presentation
- appendicitis: interestingly both as differential diagnosis and possible complication
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Assoziationen und Differentialdiagnosen zu Fitz-Hugh-Curtis-Syndrom:
