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Fitz-Hugh-Curtis syndrome

Last revised by Dr Yair Glick on 11 Sep 2021

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).

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.

Patients often present with a new-onset right upper quadrant or pleuritic chest pain on a background of pelvic inflammatory disease.

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) or Neisseria gonorrhea in fluid from the peritoneal cavity. Trichomonas vaginalis, Ureaplasma urealyticum and Mycoplasma hominis are less common causes of Fitz-Hugh-Curtis syndrome 9.

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 11,12.

Shows inflammatory changes in both pelvic and perihepatic regions.

Pelvic findings:

Perihepatic findings:

The syndrome was originally described by Arthur H Curtis in 1930 and Thomas Fitz-Hugh Jr in 1934.

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

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Cases and figures

  • Figure 1: perihepatic adhesions
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  • Case 1
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  • Case 2
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