Fitz-Hugh-Curtis syndrome

Fitz-Hugh-Curtis syndrome (FHCS), or perihepatitis, is the inflammation of the liver capsule and overlying peritoneum associated with adhesion formation, without the involvement of the hepatic parenchyma. It is a chronic complication of 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.

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) 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.

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
• gallbladder 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