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:

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