1
|
Pires V, Sucena M, Basso S. Fitz-Hugh-Curtis syndrome: a case of perihepatitis in 'mosaic' pattern. BMJ Case Rep 2022; 15:e248744. [PMID: 35236709 PMCID: PMC8895940 DOI: 10.1136/bcr-2022-248744] [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] [Accepted: 02/06/2022] [Indexed: 11/04/2022] Open
Affiliation(s)
- Verena Pires
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Mariana Sucena
- Department of Gynecology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| | - Susana Basso
- Department of Radiology, Centro Hospitalar e Universitário de Coimbra EPE, Coimbra, Portugal
| |
Collapse
|
2
|
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.
Collapse
|
3
|
de Boer JP, Verpalen IM, Gabriëls RY, de Haan H, Meijssen M, Bloembergen P, Meier M. Fitz-Hugh-Curtis syndrome resulting in nutmeg liver on computed tomography. Radiol Case Rep 2019; 14:930-933. [PMID: 31193761 PMCID: PMC6542378 DOI: 10.1016/j.radcr.2019.04.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 04/01/2019] [Accepted: 04/07/2019] [Indexed: 11/29/2022] Open
Abstract
A 34-year-old woman entered the emergency room with abdominal pain in the right upper quadrant. Computed tomography scan showed a nutmeg liver suspected for increased venous pressure by thrombosis of the liver veins, Budd-Chiari malformation, or right-sided heart failure. Interestingly, the diagnosis was pelvic inflammatory disease complicated by the Fitz-Hugh-Curtis syndrome (FHCS). Pelvic inflammatory disease resulted from an ascended infection by Chlamydia trachomatis. FHCS was caused by perihepatitis defined as inflammation of the peritoneal capsule of the liver. Fast diagnosis and treatment is crucial. Therefore, we report a case of FHCS characterized by a nutmeg liver on computed tomography.
Collapse
Affiliation(s)
- Jolien P. de Boer
- Department of Gynaecology, Isala hospital, Dokter van Heesweg 2, Zwolle 8025 AB, the Netherlands
- Corresponding author.
| | - Inez M. Verpalen
- Department of Radiology, Isala hospital, Zwolle, the Netherlands
| | - Ruben Y. Gabriëls
- Department of Gastroenterology, Isala hospital, Zwolle, the Netherlands
| | - Harm de Haan
- Department of Gynaecology, Isala hospital, Dokter van Heesweg 2, Zwolle 8025 AB, the Netherlands
| | - Maarten Meijssen
- Department of Gastroenterology, Isala hospital, Zwolle, the Netherlands
| | - Peter Bloembergen
- Laboratory of Medical Microbiology and Infectious Diseases, Isala hospital, Zwolle, the Netherlands
| | - Mark Meier
- Department of Radiology, Isala hospital, Zwolle, the Netherlands
| |
Collapse
|
4
|
Abstract
We report a case of spinal epidural abscess (SEA) in a 58-year-old woman who had recently been diagnosed with gonococcal infection, but did not receive guideline-recommended therapy. She presented with back pain and signs and symptoms of pelvic inflammatory disease (PID). MRI of the spine demonstrated epidural abscess extending from L4-L5 to T10. She underwent T10-L1 and L3-L4 laminectomies for evacuation of the abscess and Gardnerella vaginalis and Prevotella amnii were isolated from the abscess fluid cultures. Our case demonstrates SEA as a rare, but morbid complication of PID and highlights the pathogenic potential of the anaerobic flora associated with PID.
Collapse
|
5
|
Abstract
Genital and gynecologic infections are common medical problems, affecting millions of women worldwide. The spectrum of these infections extends from the labia, including processes such as necrotizing fasciitis and anogenital warts, to the upper reproductive tracts in conditions including endometritis and pelvic inflammatory disease. Although often a clinical diagnosis, the radiologist plays an important role in determining the etiology of acute abdominal and pelvic pain as well as facilitating the diagnosis for cases which are not clinically straightforward. Imaging also plays an important role in assessing the complications and sequelae of these conditions, including infertility, chronic abdominal and pelvic pain, and pelvic adhesions. Familiarity with the appearances of these infections, their complications, and their potential mimics on sonography, computed tomography, magnetic resonance imaging, and hysterosalpingography is important for timely diagnosis and optimal clinical outcomes.
Collapse
|
6
|
Revzin MV, Mathur M, Dave HB, Macer ML, Spektor M. Pelvic Inflammatory Disease: Multimodality Imaging Approach with Clinical-Pathologic Correlation. Radiographics 2016; 36:1579-1596. [PMID: 27618331 DOI: 10.1148/rg.2016150202] [Citation(s) in RCA: 67] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Pelvic inflammatory disease (PID) is a common medical problem, with almost 1 million cases diagnosed annually. Historically, PID has been a clinical diagnosis supplemented with the findings from ultrasonography (US) or magnetic resonance (MR) imaging. However, the diagnosis of PID can be challenging because the clinical manifestations may mimic those of other pelvic and abdominal processes. Given the nonspecific clinical manifestations, computed tomography (CT) is commonly the first imaging examination performed. General CT findings of early- and late-stage PID include thickening of the uterosacral ligaments, pelvic fat stranding with obscuration of fascial planes, reactive lymphadenopathy, and pelvic free fluid. Recognition of these findings, as well as those seen with cervicitis, endometritis, acute salpingitis, oophoritis, pyosalpinx, hydrosalpinx, tubo-ovarian abscess, and pyometra, is crucial in allowing prompt and accurate diagnosis. Late complications of PID include tubal damage resulting in infertility and ectopic pregnancy, peritonitis caused by uterine and/or tubo-ovarian abscess rupture, development of peritoneal adhesions resulting in bowel obstruction and/or hydroureteronephrosis, right upper abdominal inflammation (Fitz-Hugh-Curtis syndrome), and septic thrombophlebitis. Recognition of these late manifestations at CT can also aid in proper patient management. At CT, careful assessment of common PID mimics, such as endometriosis, adnexal torsion, ruptured hemorrhagic ovarian cyst, adnexal neoplasms, appendicitis, and diverticulitis, is important to avoid misinterpretation, delay in management, and unnecessary surgery. Correlation with the findings from complementary imaging examinations, such as US and MR imaging, is useful for establishing a definitive diagnosis. (©)RSNA, 2016.
Collapse
Affiliation(s)
- Margarita V Revzin
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Mahan Mathur
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Haatal B Dave
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Matthew L Macer
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| | - Michael Spektor
- From the Department of Diagnostic Radiology (M.V.R., M.M., H.B.D., M.S.) and Department of Obstetrics and Gynecology and Reproductive Sciences (M.L.M.), Yale University School of Medicine, 333 Cedar St, PO Box 208042, Room TE-2, New Haven, CT 06520
| |
Collapse
|
7
|
Gynecologic Emergencies: Findings Beyond US and Advances in Management. CURRENT RADIOLOGY REPORTS 2015. [DOI: 10.1007/s40134-015-0126-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
8
|
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]
|
9
|
Segmental hepatic concentration of 18F-FDG-labeled autologous leukocytes causing a "pseudo-lesion" on PET/CT in a patient with transient hepatic attenuation difference. Clin Nucl Med 2013; 38:e399-401. [PMID: 23989443 DOI: 10.1097/rlu.0b013e318279ec84] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Labeled leukocyte scintigraphy has been described in the detection of infection in peripancreatic fluid collections in patients with acute pancreatitis. The authors describe a sectorial hepatic concentration of 18F-FDG-labeled autologous leukocytes forming a "pseudo-lesion" on PET/CT, matching the characteristic finding of transient hepatic attenuation difference on venous phase contrast-enhanced computerized tomography.
Collapse
|
10
|
Sliker CW, Steenburg SD, Archer-Arroyo K. Emergency radiology eponyms: part 2--Naclerio's V sign to Fournier gangrene. Emerg Radiol 2012; 20:185-95. [PMID: 23065070 DOI: 10.1007/s10140-012-1082-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Accepted: 10/04/2012] [Indexed: 10/27/2022]
Abstract
An eponym is a name based on the name of a person, frequently as a means to honor him/her, and it can be used to concisely communicate or summarize a complex abnormality or injury. However, inappropriate use of an eponym may lead to potentially dangerous miscommunication. Moreover, an eponym may honor the incorrect person or a person who falls into disrepute. Despite their limitations, eponyms are still widespread in medicine. Many commonly used eponyms applied to extremity fractures should be familiar to most emergency radiologists and have been previously reported. Yet, a number of non-extremity eponyms can be encountered in an emergency radiology practice as well. This other group of eponyms encompasses a spectrum of traumatic and nontraumatic pathology. In this second part of a two-part series, the authors discuss a number of non-extremity emergency radiology eponyms, including relevant clinical and imaging features, as well biographical information of the eponyms' namesakes.
Collapse
Affiliation(s)
- Clint W Sliker
- Diagnostic Imaging Department, University of Maryland Medical Center, 22 S. Greene Street, Baltimore, MD 21201, USA.
| | | | | |
Collapse
|
11
|
Huang HH, Tsai CM, Tyan YS. Unusual cause should be kept in mind of abdominal pain in female patient. Fitz-Hugh-Curtis syndrome. Gastroenterology 2011; 140:e7-8. [PMID: 21276763 DOI: 10.1053/j.gastro.2010.02.067] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 02/01/2010] [Accepted: 02/18/2010] [Indexed: 12/02/2022]
Affiliation(s)
- Hsin-Hui Huang
- Department of Medical Imaging and School of Medical Imaging and Radiological Sciences, School of Medicine, Chung Shan Medical University Hospital and Chung Shan Medical University, Taichung, Taiwan, Republic of China
| | | | | |
Collapse
|
12
|
|
13
|
|
14
|
Le Moigne F, Lamboley JL, Vitry T, Salamand P, Milou F, Farthouat P. Intérêt du scanner avec injection dans le syndrome de Fitz-Hugh-Curtis. ACTA ACUST UNITED AC 2009; 33:1176-8. [DOI: 10.1016/j.gcb.2009.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2009] [Revised: 09/06/2009] [Accepted: 09/30/2009] [Indexed: 10/20/2022]
|
15
|
Towbin AJ, Ying J, Fleck R. Transient hepatic attenuation differences in neonates. Pediatr Radiol 2009; 39:798-803. [PMID: 19437003 DOI: 10.1007/s00247-009-1273-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2008] [Revised: 03/24/2009] [Accepted: 04/02/2009] [Indexed: 01/26/2023]
Abstract
BACKGROUND A transient hepatic attenuation difference (THAD) is a hepatic perfusion anomaly seen on contrast-enhanced CT scans caused by an alteration in the dual blood supply of the liver. Although THADs have been described in adolescents and adults, they have not previously been described in neonates. OBJECTIVE We describe the appearance and evaluate the frequency of THADs in neonates < or =1 month of age compared to other infants younger than 2 years. MATERIALS AND METHODS A retrospective study was performed looking at all CT angiograms from 2000 to 2007 in infants <2 years of age. The incidence of THADs was compared among four age groups. Significance was determined using a logistic regression model. RESULTS The study included 128 CT angiograms. A THAD was seen in 9/26 infants <1 month of age, in 3/50 infants 1 to 6 months of age, in 1/23 infants 6 months to 1 year of age, and in 1/29 infants 1 to 2 years of age. A THAD was found significantly more frequently in infants <1 month of age than in the older age groups (P<0.05). CONCLUSION THADs are benign entities that can be seen normally in the neonatal age group. When the characteristic appearance is seen on CT, no further imaging is needed.
Collapse
Affiliation(s)
- Alexander J Towbin
- Department of Radiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave. ML 5031, Cincinnati, OH 45241, USA.
| | | | | |
Collapse
|
16
|
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
| |
Collapse
|
17
|
Joo SH, Kim MJ, Lim JS, Kim JH, Kim KW. CT diagnosis of Fitz-Hugh and Curtis syndrome: value of the arterial phase scan. Korean J Radiol 2007; 8:40-7. [PMID: 17277562 PMCID: PMC2626697 DOI: 10.3348/kjr.2007.8.1.40] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Objective We wanted to evaluate the role of the arterial phase (AP) together with the portal venous phase (PP) scans in the diagnosis of Fitz-Hugh-Curtis syndrome (FHCS) with using computed tomography (CT). Materials and Methods Twenty-five patients with FHCS and 25 women presenting with non-specifically diagnosed acute abdominal pain and who underwent biphasic CT examinations were evaluated. The AP scan included the upper abdomen, and the PP scan included the whole abdomen. Two radiologists blindly and retrospectively reviewed the PP scans first and then they reviewed the AP plus PP scans. The diagnostic accuracy of FHCS on each image set was compared for each reader by analyzing the area under the receiver operating characteristic curve (Az). Weighted kappa (wk) statistics were used to measure the interobserver agreement for the presence of CT signs of the pelvic inflammatory disease (PID) on the PP images and FHCS as the diagnosis based on the increased perihepatic enhancement on both sets of images. Results The individual diagnostic accuracy of FHCS was higher on the biphasic images (Az = 0.905 and 0.942 for reader 1 and 2, respectively) than on the PP images alone (Az = 0.806 and 0.706, respectively). The interobserver agreement for the presence of PID on the PP images was moderate (wk = 0.530). The interobserver agreement for FHCS as the diagnosis was moderate on only the PP images (wk = 0.413), but it was substantial on the biphasic images (wk = 0.719). Conclusion Inclusion of the AP scan is helpful to depict the increased perihepatic enhancement, and it improves the diagnostic accuracy of FHCS on CT.
Collapse
Affiliation(s)
- Seung Ho Joo
- Department of Diagnostic Radiology, Yonsei University College of Medicine, Seoul 120-752, Korea.
| | | | | | | | | |
Collapse
|
18
|
|
19
|
Catalano O, Sandomenico F, Nunziata A, Raso MM, Vallone P, Siani A. Transient hepatic echogenicity difference on contrast-enhanced ultrasonography: sonographic sign and pitfall. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2007; 26:337-45. [PMID: 17324983 DOI: 10.7863/jum.2007.26.3.337] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
OBJECTIVE The purpose of this study was to report and analyze a new contrast-enhanced ultrasonographic (CEUS) imaging finding, the transient hepatic echogenicity difference due to perfusion changes, using computed tomography (CT) as a reference standard. METHODS We retrospectively investigated the records of patients evaluated in a 2-year period, selecting those who had undergone both CT and CEUS within 15 days, who had CT evidence of a perfusion abnormality, and who had had a CEUS study that included the malperfused parenchymal area. RESULTS There were 30 patients with 44 hepatic perfusion changes on CT scans (28 around liver focal lesions and 16 unrelated to focal lesions). Retrospectively, CEUS allowed recognition of 21 of 28 perifocal transient hepatic attenuation differences (THADs), 6 of 10 subsegmental THADs, 2 of 3 segmental THADs, and 1 of 3 lobar THADs. Only some of these abnormalities had been identified at the original CEUS examinations: 0 of 3 lobar THADs, 1 of 3 segmental THADs, 2 of 10 subsegmental THADs, and 16 of 28 perifocal THADs. CONCLUSIONS Contrast-enhanced ultrasonography can show hepatic perfusion abnormalities similar to those well known from CT literature, although with a lower sensitivity. Knowledge of this transient hepatic echogenicity difference phenomenon may be relevant for avoiding incorrect image interpretation or incorrect tumor size measurement and for eventually identifying occult vascular disorders such as venous thrombosis or fistulas.
Collapse
Affiliation(s)
- Orlando Catalano
- Department of radiology, National Cancer Institute Fondazione G. Pascale, Naples, Italy.
| | | | | | | | | | | |
Collapse
|
20
|
Abstract
Pelvic sonography is commonly performed in patients with a clinical diagnosis of pelvic inflammatory disease. Though the study may be normal or sometimes non-specific, there are a variety of findings that are characteristic of this process. Understanding of the sonographic features of pelvic inflammation, salpingitis, pyosalpinx, tubo-ovarian complex and tubo-ovarian abscess will allow the interpreter to make more specific, clinically useful diagnoses. Sonography can also help to distinguish acute from chronic abnormalities in the fallopian tubes. Correlation of sonography with pelvic CT is important as CT is ordered with increasing frequency in patients with unexplained lower abdominal pain.
Collapse
Affiliation(s)
- Mindy M Horrow
- Department of Radiology, Albert Einstein Medical Center, Philadelphia, Pennsylvania 19141-3098, USA.
| |
Collapse
|
21
|
Mesurolle B, Mignon F, Gagnon JH. Fitz-Hugh–Curtis Syndrome Caused by Chlamydia trachomatis: Atypical CT Findings. AJR Am J Roentgenol 2004; 182:822-4; author reply 824. [PMID: 14975994 DOI: 10.2214/ajr.182.3.1820822] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
|