CT findings in Fitz-Hugh-Curtis Syndrome
A 22-year old female presented to the emergency room with severe right lower quadrant (RLQ) pain radiating to the right shoulder. The pain exacerbated by changes in position and coughing; she denied nausea, vomiting, diarrhea, and fever. At physical examination, the patient presented with a soft non-distended abdomen with guarding and severe suprapubic, RLQ and right upper quadrant (RUQ) tenderness; normal bowels sound and negative rebound. Pelvic examination revealed a friable erythematous cervix with a yellowish discharge and positive cervical motion tenderness. The laboratory work-up reported a negative B-hGC, leukocytes in the upper limit of normal; basic metabolic panel and liver function tests were within normal limits.
Patient underwent a contrast enhanced CT of the abdomen and pelvis which showed diffuse liver capsule enhancement and trace perihepatic fluid. Images of the pelvis revealed a fluid filled tubular structure in the right adnexa concerning for hydrosalpinx/early tuba-ovarian abscess with associated fat stranding. The patient received IV Ceftriaxone and Azithromycin and was discharged home with oral doxycycline.
In the presence of female sexually active patients with RUQ or pelvic pain, FHCS should be consider in the differential diagnosis. Despite the risk of radiation exposure, particularly in a child bearing aged female patient, a biphasic CT (arterial and delayed images) should be consider for the initial evaluation, after abdominal US to exclude more common entities such as acute cholecystitis; however, a negative US does not completely exclude FHCS. PID long term complications may result in infertility, ectopic pregnancy, pelvic adhesions, and chronic pelvic pain. Biphasic CT findings highly correlate with PID pathological staging warranting adequate medical treatment and avoiding unnecessary invasive procedures.