CASE REPORT   

Journal of Radiological Review 2021 March;8(1):39-42

DOI: 10.23736/S2723-9284.21.00099-9

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

A rare cause of abdominal pain: Fitz-Hugh-Curtis Syndrome

Giuseppe CUTAIA ¹ ✉, Sara RUBINO ¹, Marianna MESSINA ¹, Bruno MURMURA ¹, Gabriele BUSÈ ¹, Alberto CUTAIA ², Leonardo SALVAGGIO ², Silvia AMODEO ³, Giuseppe PACI ³, Renato VENEZIA ³, Massimo MIDIRI ¹, Fabio CANNIZZARO ¹, Giuseppe SALVAGGIO ¹

¹ Section of Radiological Sciences, Department of Biomedicine, Neurosciences and Advanced Diagnostics (Bi.N.D.), University of Palermo, Palermo, Italy; ² University of Palermo, Palermo, Italy; ³ Department of Obstetrics and Gynecology, University of Palermo, Palermo, Italy

Fitz-Hugh-Curtis Syndrome (FHCS) is a rare complication of pelvic inflammatory disease (PID) characterized by inflammation of the hepatic capsule caused by ascending microbes from the genital tract. Perihepatitis and fibrous exudates can lead to the formation of adhesions described as “violin-string” between the anterior hepatic surface and the abdominal wall or the diaphragm. The main symptom is right upper quadrant pain. Hepatic capsular enhancement has been reported as a pathognomonic sign of FHCS on contrast-enhanced CT. Additional findings are ascites, fat stranding in right paracolic gutter and gallbladder wall thickening. Thickening of uterosacral ligaments, free fluid in pouch of Douglas, obscuration of pelvic fat planes, loss of definition of uterine borders, reactive lymphadenopathy are imaging findings associated with PID. Integration between clinical evaluation, gynecological examination, laboratory tests and instrumental investigations is mandatory for a correct diagnosis. Antibiotic therapy is curative, while laparoscopy can be necessary in late stages for lysis of perihepatic adhesions. Prognosis is often good.

KEY WORDS: Fitz-Hugh-Curtis syndrome; Diagnostic imaging; Abdominal pain; Pelvic inflammatory disease