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Mostafa A, Alhalabieh M, Scarano J, Dhar S, Nasir O. Fitz-Hugh-Curtis Syndrome in a Male Patient. Cureus 2024; 16:e60749. [PMID: 38903373 PMCID: PMC11188055 DOI: 10.7759/cureus.60749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2024] [Indexed: 06/22/2024] Open
Abstract
We report the case of a 38-year-old Middle Eastern man with intractable right upper quadrant (RUQ) abdominal pain and several emergency department visits during the last seven years, with extensive and repeated radiologic and endoscopic workups proven negative for biliary or upper gastrointestinal disease. He presented to our outpatient surgical clinic in March 2023 complaining of worsening RUQ and epigastric pain and was scheduled for a robotic cholecystectomy for presumed biliary dyskinesia following a repeat cholescintigraphy (hepatobiliary iminodiacetic acid) scan. During a cholecystectomy, extensive bilobar perihepatic adhesions were found, indicative of Fitz-Hugh-Curtis syndrome (FHCS). A thorough lysis of adhesions was performed along with a wedge liver biopsy, with subsequent histological examination showing chronic cholecystitis, perihepatic mesothelial fibrosis with mild subcapsular hepatic steatosis, and no evidence of liver fibrosis. The patient was examined in the clinic two weeks after surgery with complete resolution of symptoms. This case highlights the importance of considering FHCS in the differential diagnosis of male patients presenting with refractory RUQ abdominal pain despite a negative workup. Early recognition and prompt treatment can prevent unnecessary extensive, repeat testing and delays in intervention in these patients.
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Affiliation(s)
- Ahmed Mostafa
- General Surgery, Nazareth Hospital - Trinity Health Mid-Atlantic, Philadelphia, USA
| | - Mohamad Alhalabieh
- General Surgery, Nazareth Hospital - Trinity Health Mid-Atlantic, Philadelphia, USA
| | - Justin Scarano
- General Surgery, Nazareth Hospital - Trinity Health Mid-Atlantic, Philadelphia, USA
| | - Sakshi Dhar
- General Surgery, Nazareth Hospital - Trinity Health Mid-Atlantic, Philadelphia, USA
| | - Omer Nasir
- General Surgery, Nazareth Hospital - Trinity Health Mid-Atlantic, Philadelphia, USA
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2
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Shibata J, Ofuchi Y, Yonezawa N. Fitz-Hugh-Curtis syndrome: the diagnostic role of the arterial phase CT scan. BMJ Case Rep 2023; 16:e257417. [PMID: 37699745 PMCID: PMC10503322 DOI: 10.1136/bcr-2023-257417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2023] Open
Affiliation(s)
- Junpei Shibata
- Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Yuko Ofuchi
- Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
| | - Naoki Yonezawa
- Emergency and Critical Care Medicine, Yokohama City Minato Red Cross Hospital, Yokohama, Japan
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3
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Asano N, Kano Y. Fitz-Hugh Curtis syndrome. Am J Med Sci 2023; 365:e71-e72. [PMID: 36549420 DOI: 10.1016/j.amjms.2022.12.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 09/27/2022] [Accepted: 12/15/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Narumi Asano
- Department of Internal Medicine, National Hospital Organization Tochigi Medical Center, Utsunomiya, Tochigi, Japan
| | - Yasuhiro Kano
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan.
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4
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Muacevic A, Adler JR, Ueda T. Two Cases of Perihepatitis With the Liver Capsule Irritation Sign: A New Physical Examination Technique. Cureus 2023; 15:e34327. [PMID: 36865974 PMCID: PMC9972719 DOI: 10.7759/cureus.34327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
Perihepatitis, including Fitz-Hugh-Curtis syndrome, is an uncommon, chronic manifestation of pelvic inflammatory disease usually affecting premenopausal women. It causes right upper quadrant pain due to inflammation of the liver capsule and adhesion of the peritoneum. Since delayed diagnosis of Fitz-Hugh-Curtis syndrome can lead to infertility and other complications, physical examination findings need to be investigated to predict perihepatitis in the early stages of the disease. Here, we hypothesized that perihepatitis is characterized by increased tenderness and spontaneous pain in the right upper abdomen when the patient is placed in the left lateral recumbent position (we termed this indication the "liver capsule irritation sign"). We examined the patients physically for the presence of this liver capsule irritation sign for an early diagnosis of perihepatitis. We report the first two cases of perihepatitis due to Fitz-Hugh-Curtis syndrome in which the liver capsule irritation sign observed during the physical examination was used for diagnosis. The liver capsule irritation sign is caused by two mechanisms: first, the liver falls gravitationally into the left lateral recumbent position, which makes the liver easier to palpate; and second, the peritoneum is stretched and thus stimulated. The second mechanism is that the transverse colon running around the right upper abdomen slumps gravitationally when the patient is in the left lateral recumbent position, allowing for direct palpation of the liver. The liver capsule irritation sign can be a useful physical finding, suggestive of perihepatitis due to Fitz-Hugh-Curtis syndrome. It may also be suitable in cases of perihepatitis caused by factors other than Fitz-Hugh-Curtis syndrome.
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5
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Tan TH, Rajasuriar JS. 18F-FDG PET-CT in Fitz-Hugh-Curtis Syndrome. World J Nucl Med 2022; 21:166-168. [PMID: 35865150 PMCID: PMC9296242 DOI: 10.1055/s-0042-1750342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
AbstractPositron emission tomography-computed tomography (PET-CT) has demonstrated its usefulness in evaluating nonspecific abdominal and inflammatory symptoms. We report a case of young woman with chronic right upper quadrant abdominal pain. Fluorine-18 fluorodeoxyglucose PET-CT showed subhepatic hypermetabolism. Subsequent diagnostic laparoscopy confirmed the uncommon diagnosis of Fitz-Hugh-Curtis syndrome.
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Affiliation(s)
- Teik Hin Tan
- Nuclear Medicine Centre, Sunway Medical Centre, Selangor Darul Ehsan, Malaysia
| | - Jay Suriar Rajasuriar
- Oncology Centre, Gleneagles Kuala Lumpur, Jalan Ampang, Kampung Berembang, Kuala Lumpur, Malaysia
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6
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Amodeo S, Paci G, Cutaia G, Murmura B, Cannizzaro F, Venezia R. Fitz-Hugh-Curtis Syndrome Secondary to Postpartum Endometritis: Case Report and Literature Review. Gynecol Minim Invasive Ther 2021; 10:184-186. [PMID: 34485067 PMCID: PMC8384018 DOI: 10.4103/gmit.gmit_58_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/21/2020] [Accepted: 10/29/2020] [Indexed: 11/30/2022] Open
Abstract
We report a case of Fitz-Hugh-Curtis syndrome (FHCS) 1 week after an urgent cesarean section. Although its onset in the postpartum period is poorly reported in the literature, we suggest that FHCS can complicate puerperal endometritis; therefore, it should be consider in differential diagnosis in puerpera with right upper quadrant pain. Again, it can be useful to perform a contrast computed tomography that allows early diagnosis and conservative treatment.
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Affiliation(s)
- Silvia Amodeo
- Department of Obstetrics and Gynecology, University of Palermo, Palermo, Italy
| | - Giuseppe Paci
- Department of Obstetrics and Gynecology, University of Palermo, Palermo, Italy
| | - Giuseppe Cutaia
- Department of Radiological Sciences, BiND, Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy
| | - Bruno Murmura
- Department of Radiological Sciences, BiND, Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy
| | - Fabio Cannizzaro
- Department of Radiological Sciences, BiND, Paolo Giaccone University Hospital, University of Palermo, Palermo, Italy
| | - Renato Venezia
- Department of Obstetrics and Gynecology, University of Palermo, Palermo, Italy
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7
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Okumura K, Sato Y, Yonekura H, Toki N, Kuki T, Watanuki S, Nishida K. Pneumococcal perihepatitis due to hematogeneous dissemination. IDCases 2020; 21:e00856. [PMID: 32518756 PMCID: PMC7272505 DOI: 10.1016/j.idcr.2020.e00856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/30/2022] Open
Abstract
Perihepatitis can occur via hematogeneous dissemination of Streptococcus pneumoniae. A blood culture is useful for clarifying the infection route and pathogens in perihepatitis.
Perihepatitis is mainly caused by a direct extension of pelvic inflammatory disease, in which the causative pathogen is typically Neisseria gonorrhoeae or Chlamydia trachomatis. We herein discuss the case of a 61-year-old female patient who presented with a fever and right upper quadrant pain. Perihepatitis was diagnosed by contrast-enhanced computed tomography. She had no previous history of sexual activity, genital symptoms, remarkable physical findings or examination results indicative of pelvic inflammatory disease or other diseases. A blood culture detected Streptococcus pneumoniae, leading to the suspicion of hematogeneous dissemination. The patient was therefore treated with the appropriate antimicrobials. While invasive pneumococcal disease mainly results in bacteremic pneumonia, meningitis or endocarditis, the present case showed that it can also lead to perihepatitis; a blood culture is therefore useful for clarifying the infection route and pathogens in perihepatitis if the patient has no past history of sexual activity, genital symptoms or physical or other findings indicative of pelvic inflammatory disease.
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Affiliation(s)
- Koichiro Okumura
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Yu Sato
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Hiroaki Yonekura
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Noriyoshi Toki
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Takaie Kuki
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Satoshi Watanuki
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
| | - Kenji Nishida
- Department of General Internal Medicine, Tokyo Metropolitan Tama Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8524, Japan
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8
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Fitz-Hugh-Curtis syndrome: A cause of right upper quadrant abdominal pain. Med Clin (Barc) 2020; 154:447-452. [PMID: 32145988 DOI: 10.1016/j.medcli.2020.01.022] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2019] [Revised: 01/29/2020] [Accepted: 01/29/2020] [Indexed: 11/23/2022]
Abstract
Fitz-Hugh-Curtis syndrome (FHCS), also known as perihepatitis, is a rare complication of pelvic inflammatory disease. It has a different incidence depending on which diagnostic criteria are used. FHCS consists of inflammation of the hepatic capsule and surrounding peritoneum, without involvement of the hepatic parenchyma, due to intraperitoneal dissemination from a pelvic infection. Clinical manifestations are nonspecific and include a sudden onset of pain and discomfort in the right hypochondrium, commonly confused with other hepatobiliary, gastrointestinal or renal diseases. In recent years, Multidetector Computed Tomography has proven to be a very useful and non-invasive tool, which offers diagnostic confidence within the appropriate clinical setting. Radiological diagnosis of FHCS can avoid unnecessary surgical procedures.
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9
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Abstract
BACKGROUND Acute pelvic pain in women may be due to gynecological, gastrointestinal, and urinary tract disorders. Ectopic pregnancy (EP), pelvic inflammatory disease (PID), and ruptured ovarian cysts are the most common gynecological causes for acute pelvic pain and their diagnosis can be challenging. METHODS Patient history, clinical examination, and blood tests as well as patient age and potential pregnancy status help to establish the correct diagnosis. While sonography (US) remains the primary imaging modality of choice, computed tomography (CT) plays an important role in patients with indeterminate US evaluation and for treatment planning. CONCLUSION Diagnostic imaging is pivotal to differentiate potentially life- and fertility-threatening conditions from those that can be treated conservatively. Profound knowledge of the most common gynecological pathologies allows prompt and correct radiological diagnosis and assists in proper treatment planning.
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10
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Kwon OJ, Lee SW, Jang MS, Kim SC, Lee JH, Kim H. A rare case of miliary tuberculosis accompanying perihepatitis. Clin Exp Emerg Med 2019; 6:264-267. [PMID: 30743325 PMCID: PMC6774008 DOI: 10.15441/ceem.18.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Accepted: 04/26/2018] [Indexed: 01/01/2023] Open
Abstract
Perihepatic capsulitis is associated with various diseases, such as Fitz-Hugh-Curtis syndrome, systemic lupus erythematosus, perforated cholecystitis, perforated hepatic abscess, and tuberculous peritonitis. Miliary tuberculosis is present in about 2% of all reported cases of tuberculosis and is characterized by the widespread millet-like hematogenous dissemination of Mycobacterium tuberculosis. We describe a 24-year-old virgin patient presenting with right upper quadrant and costovertebral angle pain. Diffuse perihepatic capsular enhancement was observed in abdominal computed tomography scans. Chest radiography showed miliary tuberculosis, and a polymerase chain reaction hybridization assay of sputum revealed the presence of M. tuberculosis. Symptoms improved after administering anti-tuberculosis medications. This report describes a rare case of miliary tuberculosis accompanying perihepatitis.
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Affiliation(s)
- Ou Jun Kwon
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Suk Woo Lee
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Emergency Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
| | - Mun Sun Jang
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Emergency Medical Technology, Chungbuk Health & Science University, Cheongju, Korea
| | - Sang Chul Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Ji Han Lee
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Hoon Kim
- Department of Emergency Medicine, Chungbuk National University Hospital, Cheongju, Korea.,Department of Emergency Medicine, Chungbuk National University College of Medicine, Cheongju, Korea
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11
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Lee SH, Yang JI, Choi JS. A Case of Fitz-Hugh-Curtis syndrome in a male patient. KOSIN MEDICAL JOURNAL 2018. [DOI: 10.7180/kmj.2018.33.2.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Fitz-Hugh-Curtis syndrome has been described as perihepatitis associated with pelvic inflammatory disease (PID). It is classically seen in premenopausal young women who have right upper quadrant pain, usually but not always accompanied by symptoms of PID, and is frequently confused with biliary tract disease. However, the syndrome has rarely been reported in males. The predominant symptom is right upper quadrant pain, but PID may not be present in male patients. Here, we report a case of Fitz-Hugh-Curtis syndrome in a young male patient, which was diagnosed by serological tests and computed tomography. Fitz-Hugh-Curtis syndrome should be considered as a possible cause of pain in the right upper quadrant in male patients, although such a case is very rare.
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12
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Takata K, Fukuda H, Umeda K, Yamauchi R, Fukuda S, Kunimoto H, Tanaka T, Yokoyama K, Morihara D, Takeyama Y, Irie M, Shakado S, Sakisaka S. Fitz-Hugh-Curtis syndrome in a man positive for Chlamydia trachomatis. Clin J Gastroenterol 2018; 11:338-342. [PMID: 29417387 DOI: 10.1007/s12328-018-0829-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2017] [Accepted: 01/30/2018] [Indexed: 10/18/2022]
Abstract
Fitz-Hugh-Curtis syndrome (FHCS) is characterized by perihepatic and pelvic inflammation and occurs mostly in women of childbearing age. Here, we report a case of FHCS caused by Chlamydia trachomatis in a 50-year-old man. The patient presented to our hospital with right upper quadrant abdominal pain, and enhanced computed tomography revealed perihepatic and pelvic free fluid and early-phase hepatic capsular enhancement. A urine specimen was positive for Chlamydia trachomatis. The patient was diagnosed with FHCS due to Chlamydia trachomatis infection. In conclusion, FHCS cannot be excluded when men present with right upper quadrant abdominal pain without significant signs of biliary tract disease.
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Affiliation(s)
- Kazuhide Takata
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan.
| | - Hiromi Fukuda
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan
| | - Kaoru Umeda
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan
| | - Ryo Yamauchi
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan
| | - Sho Fukuda
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan
| | - Hideo Kunimoto
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan
| | - Takashi Tanaka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan
| | - Keiji Yokoyama
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan
| | - Daisuke Morihara
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan
| | - Yasuaki Takeyama
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan
| | - Makoto Irie
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan
| | - Satoshi Shakado
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan
| | - Shotaro Sakisaka
- Department of Gastroenterology and Medicine, Fukuoka University Faculty of Medicine, 7-45-1 Nanakuma, Jonan, Fukuoka, 814-0180, Japan
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13
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Acute Nontraumatic Imaging in the Liver and Spleen. Emerg Radiol 2018. [DOI: 10.1007/978-3-319-65397-6_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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14
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Zilberman-Daniels T, Cohen-Hagai K, Einbinder Y, Osadchy A, Benchetrit S, Korzets Z. Fitz-Hugh-Curtis Syndrome Consequent to a Wound Infection Following Removal of a Peritoneal Dialysis Catheter. Perit Dial Int 2017; 36:693-695. [PMID: 27903855 DOI: 10.3747/pdi.2015.00292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Fitz-Hugh-Curtis syndrome (FHCS) is a condition characterized by inflammation of the liver capsule (perihepatitis) and adjacent peritoneal surfaces. We report a case of FHCS developing in a peritoneal dialysis (PD) patient in whom catheter removal due to recurrent peritonitis was complicated by post-operative wound infection. To the best of our knowledge, this is the first case description of FHCS in the context of PD.
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Affiliation(s)
| | - Keren Cohen-Hagai
- Department of Nephrology & Hypertension, Meir Hospital, Kfar-Saba, Israel
| | - Yael Einbinder
- Department of Nephrology & Hypertension, Meir Hospital, Kfar-Saba, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Alexandra Osadchy
- Department of Radiology, Meir Hospital, Kfar-Saba, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Sydney Benchetrit
- Department of Nephrology & Hypertension, Meir Hospital, Kfar-Saba, Israel.,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
| | - Ze'ev Korzets
- Department of Nephrology & Hypertension, Meir Hospital, Kfar-Saba, Israel .,Sackler School of Medicine, Tel-Aviv University, Ramat-Aviv, Israel
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15
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Harada T, Suyama Y, Hiratsuka Y, Shimizu T. An Arterial Perihepatic Enhancement Caused by Spontaneous Bladder Rupture. Urology 2017; 100:e7-e8. [DOI: 10.1016/j.urology.2016.11.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2016] [Revised: 11/09/2016] [Accepted: 11/15/2016] [Indexed: 11/26/2022]
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16
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Mitaka H, Kitazono H, Deshpande GA, Hiraoka E. Fitz-Hugh-Curtis syndrome lacking typical characteristics of pelvic inflammatory disease. BMJ Case Rep 2016; 2016:bcr-2016-215711. [PMID: 27335367 DOI: 10.1136/bcr-2016-215711] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 23-year-old Japanese woman, previously a commercial sex worker, presented with a 2-day history of right upper quadrant (RUQ) abdominal pain, worse on deep inspiration. She had noticed increased vaginal discharge 2 months earlier and had developed dull, lower abdominal pain 3 weeks prior to presentation. Although pelvic examination and transvaginal ultrasonography revealed neither a tubal nor ovarian pathology, abdominal CT scan with contrast demonstrated early enhancement of the hepatic capsule, a finding pathognomonic for Fitz-Hugh-Curtis syndrome (FHCS). Cervical discharge PCR assay confirmed Chlamydia trachomatis infection. This case highlights that normal gynaecological evaluation may be insufficient to rule out FHCS, for which physicians should have a high index of suspicion when seeing any woman of reproductive age with RUQ pain.
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Affiliation(s)
- Hayato Mitaka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Hidetaka Kitazono
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
| | - Gautam A Deshpande
- Department of Internal Medicine, University of Hawaii, Honolulu, Hawaii, USA
| | - Eiji Hiraoka
- Department of Internal Medicine, Tokyo Bay Urayasu Ichikawa Medical Center, Urayasu, Chiba, Japan
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17
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Does the Degree of Perihepatitis Have Any Relevance to the Severity of the Manifestations of Pelvic Inflammatory Disease on Multidetector Computed Tomography? J Comput Assist Tomogr 2016; 39:901-6. [PMID: 26248151 DOI: 10.1097/rct.0000000000000291] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE This study aimed to evaluate the relationship between the degree of perihepatitis and the severity of pelvic inflammatory disease (PID) on multidetector computed tomography (MDCT). METHODS A total of 177 women with PID who underwent biphasic abdominal computed tomography (CT) scans were enrolled. Two reviewers retrospectively reviewed the CT scans with consensus and subjectively categorized the severity of PID into 4 grades (normal, mild, moderate, and severe). Another reviewer independently assigned the extent (grades 0 to 4) and the depth (grades 0 to 4) of hepatic surface enhancement in terms of the degree of perihepatitis. Relationships between the degree of perihepatitis and the CT severity as well as each CT manifestation of PID were evaluated using the χ test or a cumulative logistic regression analysis. RESULTS Of the 177 patients, 99 (55.9%) showed hepatic surface enhancement. The severity of PID on MDCT was significantly related with the degree of perihepatitis (all P < 0.001). Salpingitis, oophoritis, pelvic fat haziness, complicated ascites, and omental/mesenteric fat infiltration were significantly related with the degree of perihepatitis (all P < 0.05). Among these variables, omental/mesenteric fat infiltration (odds ratio = 10.9) and salpingitis (odds ratio = 6.0) were the CT manifestations that were most associated with the presence of perihepatitis in PID. CONCLUSIONS The degree of perihepatitis seems to show a relationship with the severity of PID on MDCT. Omental/mesenteric fat infiltration and salpingitis can be strongly related with perihepatitis in PID.
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18
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Wang PY, Zhang L, Wang X, Liu XJ, Chen L, Wang X, Wang B. Fitz-Hugh-Curtis syndrome: clinical diagnostic value of dynamic enhanced MSCT. J Phys Ther Sci 2015; 27:1641-4. [PMID: 26180288 PMCID: PMC4499951 DOI: 10.1589/jpts.27.1641] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Accepted: 02/07/2015] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to investigate the clinical diagnostic value of dynamic enhanced multislice computed tomography (MSCT) for Fitz-Hugh-Curtis syndrome (FHCS). [Subjects and Methods] This study retrospectively analyzed the clinical features and manifestations of scanning and dynamic enhanced MSCT in 19 patients with FHCS. [Results] MSCT scans showed different degrees of liver capsule thickness in the lesion area: seven cases of sub-capsular effusion and three cases with a small amount of pleural effusion; thickness of the liver capsular arterial phase showing significant enhancement in 17 cases, and slight enhancement in two; portal venous and delayed phase enhancement decreased with no clear boundary of the liver parenchyma; and adjacent hepatic parenchymal involvement in five cases, in which the arterial phase appeared to have patchy or triangular enhancement, and unclear portal vein and delayed phase imaging findings. MSCT revealed pelvic inflammatory disease in 14 cases, peritonitis in two, endometritis combined with bilateral ovarian abscesses in two, and a tube-ovarian abscess in one. [Conclusion] Dynamic enhanced MSCT can accurately display liver capsule lesions and possible pelvic inflammatory diseases related to FHCS, suggest the infection source, and have high application value for making early, accurate diagnoses and improved prognosis.
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Affiliation(s)
- Pei-Yuan Wang
- Shandong Medical Imaging Research Institute, Shandong University, China ; Department of Radiology, Affiliated Hospital of Binzhou Medical University, China ; Medical Imaging Research Institute, Binzhou Medical University, China
| | - Lin Zhang
- Shandong Medical Imaging Research Institute, Shandong University, China ; Department of Radiology, Affiliated Hospital of Binzhou Medical University, China
| | - Xia Wang
- Medical Imaging Research Institute, Binzhou Medical University, China
| | - Xin-Jiang Liu
- Department of Radiology, Affiliated Hospital of Binzhou Medical University, China
| | - Liang Chen
- Department of Radiology, Affiliated Hospital of Binzhou Medical University, China
| | - Xu Wang
- Department of Radiology, Affiliated Hospital of Binzhou Medical University, China
| | - Bin Wang
- Medical Imaging Research Institute, Binzhou Medical University, China
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Jeong TO, Song JS, Oh TH, Lee JB, Jin YH, Yoon JC. Fitz-Hugh-Curtis syndrome in a male patient due to urinary tract infection. Clin Imaging 2015; 39:917-9. [PMID: 25986163 DOI: 10.1016/j.clinimag.2015.04.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 03/30/2015] [Accepted: 04/17/2015] [Indexed: 10/23/2022]
Abstract
Fitz-Hugh-Curtis syndrome (FHCS) is inflammation of the liver capsule usually associated with pelvic inflammatory disease. FHCS has been rarely reported in male patients, and hematogenous and lymphatic spread to the liver is thought to be the underlying mechanism. Although a confirmatory diagnosis was made by laparoscopy, contrast-enhanced computed tomography scan is considered the first-line imaging tool in clinical diagnosis of FHCS. We report a case of FHCS that developed in a young male patient with a urinary tract infection.
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Affiliation(s)
- Tae Oh Jeong
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Ji Soo Song
- Department of Radiology, Chonbuk National University Medical School and Hospital, Jeonju, Korea
| | - Tae Hwan Oh
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jae Baek Lee
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Young Ho Jin
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea
| | - Jae Chol Yoon
- Department of Emergency Medicine, Research Institute of Clinical Medicine of Chonbuk National University-Biomedical Research Institute of Chonbuk National University Hospital, Jeonju, Korea.
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Comparison of diagnostic performance between single- and multiphasic contrast-enhanced abdominopelvic computed tomography in patients admitted to the emergency department with abdominal pain: potential radiation dose reduction. Eur Radiol 2014; 25:1048-58. [PMID: 25424561 DOI: 10.1007/s00330-014-3481-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2014] [Revised: 10/29/2014] [Accepted: 10/29/2014] [Indexed: 12/21/2022]
Abstract
OBJECTIVES To evaluate feasibility of radiation dose reduction by optimal phase selection of computed tomography (CT) in patients who visited the emergency department (ED) for abdominal pain. METHODS We included 253 patients who visited the ED for abdominal pain. They underwent multiphasic CT including precontrast, late arterial phase (LAP), and hepatic venous phase (HVP). Three image sets (HVP, precontrast + HVP, and precontrast + LAP + HVP) were reviewed. Two reviewers determined the most appropriate diagnosis with five-point confidence scale. Diagnostic performances were compared among image sets by weighted-least-squares method or DeLong's method. Linear mixed model was used to assess changes of diagnostic confidence and radiation dose. RESULTS There was no difference in diagnostic performance among three image sets, although diagnostic confidence level was significantly improved after review of triphasic images compared with both HVP images only or HVP with precontrast images (confidence scale, 4.64 ± 0.05, 4.66 ± 0.05, and 4.76 ± 0.04 in the order of the sets; overall P = 0.0008). Similar trends were observed in the subgroup analysis for diagnosis of pelvic inflammatory disease and cholecystitis. CONCLUSIONS There is no difference between HVP-CT alone and multiphasic CT for the diagnosis of causes of abdominal pain in patients admitted to the ED without prior chronic disease or neoplasia. KEY POINTS • There was no difference in diagnostic performance of HVP CT and multiphasic CT. • The diagnostic confidence level was improved after review of the LAP images. • HVP CT can achieve diagnostic performance similar to that of multiphasic CT, while minimizing radiation.
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Beranger-Gibert S, Lagadec M, Boulay-Coletta I, Petit E, Barrau V, Zins M, Vilgrain V, Ronot M. Hepatic and perihepatic involvement of female genital diseases and pregnancy: a review. ACTA ACUST UNITED AC 2014; 40:1331-49. [DOI: 10.1007/s00261-014-0263-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Katz DS, Khalid M, Coronel EE, Mazzie JP. Computed Tomography Imaging of the Acute Pelvis in Females. Can Assoc Radiol J 2013; 64:108-18. [DOI: 10.1016/j.carj.2012.11.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2012] [Accepted: 11/22/2012] [Indexed: 12/30/2022] Open
Abstract
Sonography is the primary imaging modality for the evaluation of pelvic pain in female patients, especially if gynaecological pathology is suspected. However, computed tomography (CT) is frequently used in patients who present to emergency departments (and elsewhere) with otherwise nonspecific abdominal and pelvic pain and may be the first imaging modality to demonstrate an acute gynaecological abnormality. Computed tomography can also be used prospectively in selected patients to further evaluate findings initially identified on sonography, although to reduce radiation exposure, magnetic resonance imaging is being used more frequently in this situation. The purpose of this article is to discuss the spectrum of gynaecological findings of the acute female pelvis that may be identified on CT by the emergency radiologist and by the general radiologist, with a brief review of the imaging literature of each specific diagnosis.
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Affiliation(s)
- Douglas S. Katz
- Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA
| | - Maria Khalid
- Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA
| | - Esther E. Coronel
- Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA
| | - Joseph P. Mazzie
- Department of Radiology, Winthrop-University Hospital, Mineola, New York, USA
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Acute Nontraumatic Imaging in the Liver and Spleen. Emerg Radiol 2013. [DOI: 10.1007/978-1-4419-9592-6_10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Bouquier J, Fauconnier A, Fraser W, Dumont A, Huchon C. Diagnostic d’une infection génitale haute. Quels critères cliniques, paracliniques ? Place de l’imagerie et de la cœlioscopie ? ACTA ACUST UNITED AC 2012; 41:835-49. [DOI: 10.1016/j.jgyn.2012.09.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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You JS, Kim MJ, Chung HS, Chung YE, Park I, Chung SP, Kim S, Lee HS. Clinical features of Fitz-Hugh-Curtis Syndrome in the emergency department. Yonsei Med J 2012; 53:753-8. [PMID: 22665342 PMCID: PMC3381477 DOI: 10.3349/ymj.2012.53.4.753] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Fitz-Hugh-Curtis Syndrome (FHCS) is a clinical entity characterized by inflammation of the liver capsule associated with genital tract infection. The aim of this study is to provide physicians with clinical suggestions for diagnostic approaches based on a series of patients who were diagnosed with FHCS. MATERIALS AND METHODS We conducted a retrospective study of patients who were diagnosed with FHCS after presenting to the emergency department (ED). The symptoms, physical examinations, laboratory findings, radiological findings, and progress of the patients were reviewed. RESULTS During the four-year study period, a total of 82 female patients received a final diagnosis of FHCS in the ED. Chlamydia trachomatis was identified as a pathogen in 89% of the patients. Their clinical characteristics and laboratory findings were described. Fifty-two patients (63.4%) were admitted to the hospital. All of the admitted patients improved after treatment combining antibiotic therapy with conservative care. CONCLUSION FHCS should be considered as a differential diagnosis for female patients of childbearing age with right upper abdominal pain. Timely diagnosis using biphasic computed tomography (CT) with arterial and portal phases may help ensure adequate medical treatment as well as avoid invasive procedures.
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Affiliation(s)
- Je Sung You
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Min Joung Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hyun Soo Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Yong Eun Chung
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul, Korea
| | - Incheol Park
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Phil Chung
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Seungho Kim
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
| | - Hahn Shick Lee
- Department of Emergency Medicine, Yonsei University College of Medicine, Seoul, Korea
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Lee GH, Kim HJ, Park CH, Chun YJ, Choi HJ, Lee HN, Cho S. Frequency of N. gonorrheaee, C. trachomatis, U. urealyticumand M. hominisin Pelvic Inflammatory Disease and Fitz-Hugh-Curtis Syndrome. Infect Chemother 2012. [DOI: 10.3947/ic.2012.44.5.362] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Gyoung Hoon Lee
- Department of Obstetrics and Gynecology, Seoul Medical Center, Seoul, Korea
| | - Hye Ji Kim
- Department of Obstetrics and Gynecology, Seoul Medical Center, Seoul, Korea
| | - Chul Hi Park
- Department of Radiology, Seoul Medical Center, Seoul, Korea
| | - Yoon Jung Chun
- Department of Obstetrics and Gynecology, Seoul Medical Center, Seoul, Korea
| | - Hyun Jung Choi
- Department of Obstetrics and Gynecology, Seoul Medical Center, Seoul, Korea
| | - Han Na Lee
- Department of Obstetrics and Gynecology, Seoul Medical Center, Seoul, Korea
| | - Sook Cho
- Department of Obstetrics and Gynecology, Seoul Medical Center, Seoul, Korea
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Baek HC, Bae YS, Lee KJ, Kim DH, Bae SH, Kim DW, Yoon JB, Song CS. [A case of Fitz-Hugh-Curtis syndrome in a male]. THE KOREAN JOURNAL OF GASTROENTEROLOGY 2010; 55:203-7. [PMID: 20357533 DOI: 10.4166/kjg.2010.55.3.203] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Fitz-Hugh-Curtis syndrome has been described as focal perihepatitis accompanying pelvic inflammatory disease caused by Neisseria gonorrhea and Chlamydia trachomatis. The highest incidence occurs in young, sexually active females. However, the syndrome has been reported to occur infrequently in males, according to the foreign literature. The predominant symptoms are right upper quadrant pain and tenderness, and pleuritic right sided chest pain. The clinical presentation is similar in men and women. In women, the spread of infection to liver capsule is thought to occur directly from infected fallopian tube via the right paracolic gutter. In men, hematogenous and lymphatic spread is thought to be postulated. Recently, we experienced a case of Fitz-Hugh-Curtis syndrome occurred in a man. As far as we know, it is the first report in Korea, and we report a case with a review of the literature.
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Affiliation(s)
- Hyun Choul Baek
- Department of Internal Medicine, Good Samsun Hospital, Sasang-gu, Busan, Korea
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Kim JH, Oh SH. Two adolescent cases of Fitz-Hugh-Curtis syndrome. KOREAN JOURNAL OF PEDIATRICS 2009. [DOI: 10.3345/kjp.2009.52.9.1038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ji Hye Kim
- Department of Pediatrics, Hanyang University School of Medicine, Seoul, Korea
| | - Sung Hee Oh
- Department of Pediatrics, Hanyang University School of Medicine, Seoul, Korea
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Perihepatitis with pelvic inflammatory disease (PID) on MDCT: characteristic findings and relevance to PID. ACTA ACUST UNITED AC 2008; 34:737-42. [DOI: 10.1007/s00261-008-9472-9] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2008] [Accepted: 10/16/2008] [Indexed: 10/21/2022]
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Yang HW, Jung SH, Han HY, Kim A, Lee YJ, Cha SW, Go H, Choi GY, Cho SH, Lim SH. Clinical feature of Fitz-Hugh-Curtis syndrome: Analysis of 25 cases. THE KOREAN JOURNAL OF HEPATOLOGY 2008; 14:178-84. [DOI: 10.3350/kjhep.2008.14.2.178] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Hyeon Woong Yang
- Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea
| | - Sung Hee Jung
- Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea
| | - Hyun Young Han
- Department of Radiology, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea
| | - Anna Kim
- Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea
| | - Yun Jung Lee
- Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea
| | - Sang Woo Cha
- Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea
| | - Hun Go
- Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea
| | - Gi Young Choi
- Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea
| | - Soung Hoon Cho
- Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea
| | - Sin Hyung Lim
- Department of Internal Medicine, Eulji University College of Medicine, Eulji University Hospital, Daejeon, Korea
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Cho HJ, Kim HK, Suh JH, Lee GJ, Shim JC, Kim YH. Fitz-Hugh-Curtis syndrome: CT findings of three cases. Emerg Radiol 2007; 15:43-6. [PMID: 17582537 DOI: 10.1007/s10140-007-0635-8] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2007] [Accepted: 05/22/2007] [Indexed: 12/23/2022]
Abstract
Clinical manifestations and computed tomography (CT) findings of Fitz-Hugh-Curtis syndrome (FHCS) are relatively well stabilized as right upper quadrant abdominal pain and hepatic capsular enhancement because of perihepatitis associated with pelvic inflammatory disease caused by N. gonorrhoeae and C. trachomatis. We encountered three patients with serial FHCS associated with pelvic inflammatory disease, who visited the emergency room with right upper quadrant abdominal pain. Abdominal CT revealed hepatic capsular or pericapsular enhancement along the anterior surface of the liver on the arterial phase. Recently, multi-detector CT has evolved as the first-line imaging modality of acute abdomen at the emergency room; we reemphasized the importance of the CT findings of this syndrome for differential diagnosis of right upper quadrant abdominal pain in sexually active young women. Physicians at the emergency room acknowledge the syndrome and should perform dynamic abdominopelvic CT including the arterial phase.
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Affiliation(s)
- Hyeon Je Cho
- Department of Diagnostic Radiology, Inje University College of Medicine, Seoul Paik Hospital, #85, 2-Ga, Jeo-dong, Jung-Gu, Seoul, South Korea, 100-032.
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