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Case Reports
. 2022 Jul-Sep;15(3):146-148.
doi: 10.4103/JETS.JETS_136_20. Epub 2022 Sep 28.

Ultrasound Killed the Pelvic Examination: Over-reliance on Ultrasound Resulted in Delayed Diagnosis of Fitz-Hugh-Curtis Syndrome and Potential Loss of Fertility in a Young Female Patient

Luke Lin  1 , Alfredo Tirado  1 , Erin Mateer  1 , Sagar Galwankar  1 , Veronica Tucci  1
Affiliations
Case Reports

Ultrasound Killed the Pelvic Examination: Over-reliance on Ultrasound Resulted in Delayed Diagnosis of Fitz-Hugh-Curtis Syndrome and Potential Loss of Fertility in a Young Female Patient

Luke Lin et al. J Emerg Trauma Shock. 2022 Jul-Sep.

Abstract

We describe a case of multiple missed opportunities to diagnose Fitz-Hugh-Curtis syndrome in a sexually active 26-year-old woman in the emergency department (ED). Repeat ultrasound scans showed a hemorrhagic ovarian cyst. Multiple ED providers relied exclusively on these ultrasound findings as the presumed cause of her pelvic pain, to the detriment of their physical examination. A manual pelvic examination was not performed until her fourth ED return visit, which showed mucopurulent discharge. On the basis of our findings, obstetrics and gynecology team was consulted and the patient underwent diagnostic laparoscopy, which revealed extensive adhesions suggestive of pelvic inflammatory disease (PID) and Fitz-Hugh-Curtis syndrome. With the advent of ultrasound, we have noticed providers rely on technology to the detriment of their physical examination skills. Many ED providers are hesitant to perform a pelvic examination when a transvaginal ultrasound has already suggested a cause of the patient's pain. Ultrasound will not and cannot diagnose PID.

Keywords: Fitz-Hugh–Curtis; pelvic examination; pelvic inflammatory disease; ultrasound.

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Conflict of interest statement

One of the authors is on the editorial board of this journal.

Figures

Figure 1
Figure 1
Pelvic Ultrasound showing a hemorrhagic ovarian cyst
See this image and copyright information in PMC

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