Fitz-Hugh-Curtis syndrome

Background
"Violin string sign", adhesions between the liver and abdominal wall.
  • A complication of Pelvic Inflammatory Disease, involving acute gonococcal or chlamydia trachomatis peritonitis of the right upper quadrant in women
  • Pain is caused by liver capsule inflammation

Clinical Features[1]

Differential Diagnosis

RUQ Pain

Evaluation
  • Aminotransferases usually normal or mildly elevated [1]
    • Generally not markedly elevated [2][3]
  • If CT obtained, may show inflammatory changes in pelvic and perihepatic regions
  • Ultimately a diagnosis of exclusion with supporting evidence of gonorrhea or chlamydia

Management

Disposition
  • Admission criteria same for PID
    • Pregnancy
    • Toxic, systemic symptoms
    • Poor compliance
    • Failure of outpatient therapy
    • Tubo-ovarian abscess

See Also
  • PID

References
  1. Livengood et al. Clinical features and diagnosis of pelvic inflammatory disease. Uptodate.
  2. Curtis AH. A cause of adhesion in the right upper quadrant.JAMA. 1930;94(16):1221-1222. doi:10.1001/jama.1930.02710420033012.
  3. Peter, N. G.; Clark, L. R.; Jaeger, J. R. (2004). "Fitz-Hugh-Curtis syndrome: a diagnosis to consider in women with right upper quadrant pain". Cleveland Clinic journal of medicine 71 (3): 233–239. doi:10.3949/ccjm.71.3.233. PMID 15055246
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