Yeungnam Univ J Med.  2018 Jun;35(1):127-129. 10.12701/yujm.2018.35.1.127.

Ultrasonographic findings in Fitz-Hugh-Curtis syndrome: a thickened or three-layer hepatic capsule

• Moon YH
• Kim JH
• Jeong WJ
• Park SY

• KMID: 2415746
• DOI: http://doi.org/10.12701/yujm.2018.35.1.127

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.

Keyword

Pelvic inflammatory disease; Ultrasonography; Abdominal pain

MeSH Terms

Abdominal Pain
Adolescent
Capsules
Emergency Service, Hospital
Female
Humans
Inflammation
Pelvic Inflammatory Disease
Point-of-Care Systems
Ultrasonography
Capsules

Figure

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  Fig. 1. POCUS and CECT findings of the patient. (A) Right subcostal POCUS scan showing abnormal thickening (0.74 cm) between the liver and the diaphragm. (B) According to the scan angle and respiration, the hepatic capsule is shown as three layers on the right subcostal scan. The inner hyperechoic (blue arrow), middle hypoechoic (white arrow), and outer hyperechoic layers (red arrow) of the hepatic capsule are thought to indicate the inflammation of the liver surface, a small amount of ascites, and the inflammation of the diaphragm or abdominal wall, respectively. (C) In the arterial phase of the CECT scan, hepatic capsular enhancement (red arrowhead) and a small amount of localized ascites (white arrowhead) were observed on the surface of segment IV of the liver. POCUS, point-of-care ultrasonography; CECT, contrast-enhanced computed tomography.

Reference

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