Fitz-Hugh-Curtis syndrome

Case contributed by Dr Euan Zhang

Presentation

Severe RLQ and RUQ pain and nausea/vomting. Equivocal ultrasound findings for appendicitis.

Patient Data

Age: 22
Gender: Female
CT

CT Abdomen/pelvis

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.

CT

CT Findings

Inflammatory stranding in the pelvis extending to the right perihepatic space.  THAD 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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Case information

rID: 51164
Case created: 6th Feb 2017
Last edited: 23rd Oct 2017
Inclusion in quiz mode: Included

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