Fitz-Hugh-Curtis syndrome

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

Epidemiology

The prevalence in adults with mild to moderate PID (gonorrhoic) may approximate 4% ¹⁰. The prevalence may be higher in genital tuberculosis ¹².It most commonly occurs in women of child bearing age, however, it rarely has been 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 direct intraperitoneal spread of infection towards the perihepatic region from initial pelvic inflammation/infection.

Diagnosis may be confirmed by presence of Neisseriae gonorrheae or Chlamydia trachomatis in fluid from the peritoneal cavity. Trichomonas vaginalis, Ureaplasma urealyticum and Mycoplasma hominis may also cause FHCS 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 peri hepaticperihepatic region.
• often shows hepatic capsular enhancement ²
• gall bladder wall thickening ³
• peri cholecystic inflammatory change ³
• transient hepatic perfusional abnomalities

History and etymology

The syndrome was origininally 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 solid component, overt pelvic malignancy on imaging and has a different clinical presentation
• appendicitis: interestingly both as differential diagnosis and possible complication ⁹