Fitz-Hugh-Curtis syndrome

Fitz-Hugh-Curtis syndrome (FHCS) refers to the development of perihepatitis in association with pelvic inflammatory disease (PID). 

Epidemiology

The prevalence in adults with mild to moderate PIDpelvic inflammatory disease (gonorrhoea) may approximate 4% ¹⁰. The prevalence may be higher in genital tuberculosis ¹². It most commonly occurs in women of childbearing age, however; however, there have been rare cases reported in males ^7,8. 

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 gonorrhoea or Chlamydia trachomatis in fluid from the peritoneal cavity. Trichomonas vaginalis, Ureaplasma urealyticum and Mycoplasma hominis may also cause FHCSFitz-Hugh-Curtis syndrome ⁹.

It has been demonstrated to occur in genital tuberculosis as well, and Mycobacterium tuberculosis may even be the dominating aetiologic agent in endemic areas of developing countries ^11,12.

Radiographic features

CT

Shows inflammatory changes in both pelvic and perihepatic regions.

Pelvic findings:

• may show a tubo-ovarian abscess

Perihepatic findings:

• can show inflammatory stranding and fluid along the right paracolic gutter as well as the perihepatic region
• often shows hepatic capsular enhancement ²
• gall bladder wall thickening ³
• pericholecystic inflammatory change ³
• 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 ⁹