Fitz-Hugh-Curtis syndrome resulting in nutmeg liver on computed tomography

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.

Keywords: Chlamydia trachomatis; FHCS, Fitz-Hugh-Curtis syndrome; Fitz-Hugh-Curtis syndrome; GP, general practitioner; Hepatomegaly; IUD, intrauterine device; Nutmeg liver; PID, pelvic inflammatory disease; Pelvic Inflammatory disease; Perihepatitis.

Fig. 1

Contrast-enhanced CT scan of the enlarged liver in axial, coronal, and sagittal dimension (right to left) demonstrates hepatic parenchymal attenuation differences, also called a “nutmeg liver.”

Fig. 2

Early phase contrast-enhanced CT scan of the liver showing hyperintense enhancement of the anterior hepatic capsule of the right lobe.

Fig. 3

Contrast-enhanced CT scan of the pelvis, which demonstrates enhanced and thickened fallopian tubes suspected for salpingitis. Additionally, the ovaries are enlarged, inflamed, and have a cystic appearance due to early oophoritis. Moreover, pelvic fat inflammation and free fluid is seen.

Fig. 4

A zone of low attenuation around the central portal veins is seen, which indicates that there is periportal edema present, also referred to as periportal halo sign.