Fitz-Hugh-Curtis syndrome
Updates to Article Attributes
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 complicationof pelvic inflammatory disease (PID).
Epidemiology
The prevalence in women with mild to moderate pelvic inflammatory disease may approximate 4% 10. The prevalence may be higher in genital tuberculosis 12. It most commonly occurs in women of childbearing age; however, there have been rare cases reported in males 7,8. While many organisms are associated with Fitz-Hugh-Curtis syndrome, Chlamydia trachomatis is the most common pathogen involved13.
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 Chlamydia trachomatis (most common 13) orNeisseria gonorrhoea or Chlamydia trachomatis in fluid from the peritoneal cavity. Trichomonas vaginalis, Ureaplasma urealyticum and Mycoplasma hominis are less common causes may also causeof Fitz-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
- 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 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
-<p><strong>Fitz-Hugh-Curtis syndrome (FHCS),</strong> or <strong>perihepatitis</strong>, 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<strong> </strong>of <a href="/articles/pelvic-inflammatory-disease">pelvic inflammatory disease</a> (PID).</p><h4>Epidemiology</h4><p>The prevalence in women with mild to moderate pelvic inflammatory disease may approximate 4% <sup>10</sup>. The prevalence may be higher in genital tuberculosis <sup>12</sup>. It most commonly occurs in women of childbearing age; however, there have been rare cases reported in males <sup>7,8</sup>. While many organisms are associated with Fitz-Hugh-Curtis syndrome, <em>Chlamydia trachomatis </em>is the most common pathogen involved<sup>13</sup>.</p><h4>Clinical presentation</h4><p>Patients often present with a new-onset right upper quadrant or pleuritic chest pain on a background of pelvic inflammatory disease.</p><h4>Pathology</h4><p>It is thought to result from the direct intraperitoneal spread of infection towards the perihepatic region from initial pelvic inflammation/infection.</p><p>Diagnosis may be confirmed by the presence of <em>Neisseria gonorrhoea</em> or <em>Chlamydia trachomatis</em> in fluid from the peritoneal cavity. <em>Trichomonas vaginalis, Ureaplasma urealyticum</em> and <em>Mycoplasma hominis </em>may also cause Fitz-Hugh-Curtis syndrome <sup>9</sup><em>. </em></p><p>It has been demonstrated to occur in genital tuberculosis as well, and <a href="/articles/mycobacterium-tuberculosis"><em>Mycobacterium tuberculosis</em></a> may even be the dominating aetiologic agent in endemic areas of developing countries <sup>11,12</sup>.</p><h4>Radiographic features</h4><h5>CT</h5><p>Shows inflammatory changes in both pelvic and perihepatic regions.</p><p>Pelvic findings:</p><ul>- +<p><strong>Fitz-Hugh-Curtis syndrome (FHCS),</strong> or <strong>perihepatitis</strong>, 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<strong> </strong>of <a href="/articles/pelvic-inflammatory-disease">pelvic inflammatory disease</a> (PID).</p><h4>Epidemiology</h4><p>The prevalence in women with mild to moderate pelvic inflammatory disease may approximate 4% <sup>10</sup>. The prevalence may be higher in genital tuberculosis <sup>12</sup>. It most commonly occurs in women of childbearing age; however, there have been rare cases reported in males <sup>7,8</sup>.</p><h4>Clinical presentation</h4><p>Patients often present with a new-onset right upper quadrant or pleuritic chest pain on a background of pelvic inflammatory disease.</p><h4>Pathology</h4><p>It is thought to result from the direct intraperitoneal spread of infection towards the perihepatic region from initial pelvic inflammation/infection.</p><p>Diagnosis may be confirmed by the presence of <em>Chlamydia trachomatis</em> (most common <sup>13</sup>) or<em> Neisseria gonorrhoea</em> in fluid from the peritoneal cavity. <em>Trichomonas vaginalis, Ureaplasma urealyticum</em> and <em>Mycoplasma hominis</em> are less common <em>causes </em>of Fitz-Hugh-Curtis syndrome <sup>9</sup><em>. </em></p><p>It has been demonstrated to occur in genital tuberculosis as well, and <a href="/articles/mycobacterium-tuberculosis"><em>Mycobacterium tuberculosis</em></a> may even be the dominating aetiologic agent in endemic areas of developing countries <sup>11,12</sup>.</p><h4>Radiographic features</h4><h5>CT</h5><p>Shows inflammatory changes in both pelvic and perihepatic regions.</p><p>Pelvic findings:</p><ul>
Systems changed:
- Hepatobiliary