Ultrasonographic findings in Fitz-Hugh-Curtis syndrome: a thickened or three-layer hepatic capsule
You Ho Moon1, Jung Ho Kim2, Won Joon Jeong3
1Department of Emergency Medicine, Daegu Fatima Hospital, Daegu, Korea.
Insights
Fitz-Hugh-Curtis syndrome (FHCS) can be challenging to diagnose early. Point-of-care ultrasonography may reveal a thickened hepatic capsule, aiding in early FHCS recognition.
Area of Science:
- Hepatology
- Radiology
- Gynecology
Background:
- Fitz-Hugh-Curtis syndrome (FHCS) involves inflammation of the perihepatic capsules, often linked to pelvic inflammatory disease (PID).
- Early FHCS diagnosis is difficult due to non-specific symptoms mimicking other conditions, potentially leading to increased costs and prolonged treatment.
- Contrast-enhanced computed tomography (CECT) is effective but requires high clinical suspicion.
Observation:
- Point-of-care ultrasonography was performed on an 18-year-old female presenting with right upper quadrant (RUQ) abdominal pain, notably without PID symptoms.
- The ultrasonography revealed a thickened, three-layer hepatic capsule.
Findings:
- The ultrasonographic finding of a thickened hepatic capsule correlated with increased capsular enhancement in the arterial phase on CECT.
- This suggests ultrasonography can identify specific signs of FHCS.
Implications:
- Ultrasonography may serve as an accessible tool for early FHCS detection in women of childbearing age with RUQ pain.
- Identifying a thickened hepatic capsule on ultrasound, in the absence of other common causes, warrants consideration for FHCS.
- This could lead to earlier treatment and improved patient outcomes.
Abstract:
Fitz-Hugh-Curtis syndrome (FHCS) is characterized by inflammation of the perihepatic capsules associated with the pelvic inflammatory disease (PID). FHCS is not a serious disease, but if not treated properly, it can result in increased medical costs, prolonged treatment, and dissatisfaction with treatment. However, early recognition of FHCS in the emergency department can be difficult because its symptoms or physical findings may mimic many other diseases. Although contrast-enhanced computed tomography (CECT) is the useful imaging modality for recognition of FHCS, it is available only when a high suspicion is established. We performed point-of-care ultrasonography in an 18-year-old woman who had a sharp right upper quadrant (RUQ) abdominal pain without PID symptoms and found a thickened or three-layer hepatic capsule. These findings coincided with areas showing increased hepatic capsular enhancement in the arterial phase of CECT. These results show that if the thickened or three-layer hepatic capsule without evidence of a common cause of RUQ pain is observed on ultrasonography in women of childbearing age with RUQ abdominal pain, the physician can consider the possibility of FHCS.
Related Concept Videos
01:25Ultrasound II: Endoscopic Ultrasound and FibroScan
Endoscopic Ultrasound (EUS):
01:17Ultrasonography
During an ultrasonography procedure, a handheld device called...
01:24Imaging Studies II: Ultrasonography
01:17Gross Anatomy of the Liver
Located under the diaphragm, the liver is almost entirely ensconced within the rib cage, providing it with substantial protection. Except for the superior most bare area, the liver's surface is...
01:29Cardiomyopathy III: Hypertrophic Cardiomyopathy
01:20Ultrasound I: Abdominal Ultrasonography
Abdominal ultrasonography, commonly known as abdominal ultrasound, is a vital, non-invasive medical imaging technique widely used in healthcare.
Procedure:
This diagnostic tool allows the clinician to visually inspect internal structures within the abdomen, including vital organs such as the liver, gallbladder, pancreas, kidneys, and spleen.
The abdominal ultrasound process begins with applying a special gel to the patient's skin over the abdomen. This gel enhances the...