Presentation
Severe right upper and lower quadrant abdominal pain and nausea/vomiting. Equivocal ultrasound findings for appendicitis.
Patient Data
The pelvis contains a small volume of complex fluid within the pouch of Douglas, with peritoneal enhancement. Mesenteric stranding extends superiorly from this collection to just above the urinary bladder, into the bilateral paracolic gutters and the right perihepatic space.
The right subcapsular liver margin contains a thin hyperdensity, likely representing a transient hepatic attenuation difference. A trace amount of stranding abuts the right liver margin as well. The liver exhibits a mild degree of periportal edema.
There are strands of soft tissue permeation (mesenteric stranding) throughout the pelvis, right lower quadrant and right paracolic gutter. These regions are associated with local peritoneal thickening and enhancement. Inflammatory change extends to the liver, which exhibits transient hepatic attenuation differences in the right liver margin.
Case Discussion
Chlamydia trachomatis antigen was detected in the urine by nucleic acid amplification.
This is a subtle case of Fitz-Hugh-Curtis syndrome, whereby inflammatory fluid from the patient's PID extended superiorly to involve the liver, causing both right upper and lower quadrant pain.
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