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 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 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.
Shows inflammatory changes in both pelvic and perihepatic regions.
- may show a tubo-ovarian abscess
- 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
- peri cholecystic 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.
Imaging differential considerations include:
- 1. Sam JW, Jacobs JE, Birnbaum BA. Spectrum of CT findings in acute pyogenic pelvic inflammatory disease. Radiographics. 22 (6): 1327-34. doi:10.1148/rg.226025062 - Pubmed citation
- 2. Kim S, Kim TU, Lee JW et-al. The perihepatic space: comprehensive anatomy and CT features of pathologic conditions. Radiographics. 27 (1): 129-43. doi:10.1148/rg.271065050 - Pubmed citation
- 3. Pickhardt PJ, Fleishman MJ, Fisher AJ. Fitz-Hugh-Curtis syndrome: multidetector CT findings of transient hepatic attenuation difference and gallbladder wall thickening. AJR Am J Roentgenol. 2003;180 (6): 1605-6. AJR Am J Roentgenol (full text) - Pubmed citation
- 4. Mesurolle B, Mignon F, Gagnon JH. Fitz-Hugh-Curtis syndrome caused by Chlamydia trachomatis: atypical CT findings. AJR Am J Roentgenol. 2004;182 (3): 822-4. AJR Am J Roentgenol (full text) - Pubmed citation
- 5. Cho HJ, Kim HK, Suh JH et-al. Fitz-Hugh-Curtis syndrome: CT findings of three cases. Emerg Radiol. 2008;15 (1): 43-6. doi:10.1007/s10140-007-0635-8 - Pubmed citation
- 6. Kim JY, Kim Y, Jeong WK et-al. Perihepatitis with pelvic inflammatory disease (PID) on MDCT: characteristic findings and relevance to PID. Abdom Imaging. 2009;34 (6): 737-42. doi:10.1007/s00261-008-9472-9 - Pubmed citation
- 7. Saurabh S, Unger E, Pavlides C. Fitz-hugh-curtis syndrome in a male patient: a case report and literature review. Case Rep Surg. 2012;2012: 457272. doi:10.1155/2012/457272 - Free text at pubmed - Pubmed citation
- 8. Baek HC, Bae YS, Lee KJ et-al. A case of Fitz-Hugh-Curtis syndrome in a male. Korean J Gastroenterol. 2010;55 (3): 203-7. Pubmed citation
- 9. Kazama I, Nakajima T. A case of fitz-hugh-curtis syndrome complicated by appendicitis conservatively treated with antibiotics. Clin Med Insights Case Rep. 2013;6: 35-40. doi:10.4137/CCRep.S11522 - Free text at pubmed - Pubmed citation
- 10. Risser WL, Risser JM, Benjamins LJ et-al. Incidence of Fitz-Hugh-Curtis syndrome in adolescents who have pelvic inflammatory disease. J Pediatr Adolesc Gynecol. 2007;20 (3): 179-80. doi:10.1016/j.jpag.2006.08.004 - Pubmed citation
- 11. Sharma JB, Malhotra M, Arora R. Fitz-Hugh-Curtis syndrome as a result of genital tuberculosis: a report of three cases. Acta Obstet Gynecol Scand. 2003;82 (3): 295-7. Pubmed citation
- 12. Sharma JB, Roy KK, Gupta N et-al. High prevalence of Fitz-Hugh-Curtis Syndrome in genital tuberculosis. Int J Gynaecol Obstet. 2007;99 (1): 62-3. doi:10.1016/j.ijgo.2007.03.024 - Pubmed citation