Aortic aneurysm caused by schistosomiasis.

Abstract

There has not been a previous report of schistosomiasis pro The haemoglobin concentration was 9 7 g/dl, and the white blood cell count 16 x 109/l with an eosinophilia of 10%. There was blood in the urine but no ova of Schistosoma were identified. Stools showed the ova of S mansoni, as did a biopsy specimen of the rectal mucosa. Serological tests for syphilis (Venereal Disease Research Laboratory, Wassermann reaction) were negative. The results of liver function tests, including the prothrombin index, were normal.A left thoracotomy was made and extended transsternally to the right inframammary fold. The left upper lobe was firm, shrunken, and airless, and densely adherent to the aneurysm. There was a granulomatous inflammatory reaction in the lung, extending through the pleura and inseparably merging with abnormal aortic wall. The aorta was aneurysmal from 5 cm proximal to the brachiocephalic arAddress for reprint requests: Dr EA Vanker, Department of Tho-

A Huge Thrombosed Pulmonary Artery Aneurysm without Pulmonary Hypertension in a Patient with Hepatosplenic Schistosomiasis

“…In this respect, obliterative endarteritis in the vasa vasorum of the large pulmonary arteries in cases of pulmonary schistosomiasis has been reported to weaken their walls, leading to dilatation even in the absence of pulmonary hypertension [8]. Interestingly, the same mechanism was specified in the first reported case of schistosomal aortic aneurysm, where an extensive infestation of the left upper lobe by ova of Schistosoma mansoni caused extension of the disease into the adjacent pleura and aortic sheath, producing endarteritis obliterans of the vasa vasorum of the aorta and subsequent formation of an aortic aneurysm in the absence of systemic hypertension [12]. …”

Blood Flukes and Arterial Damage: A Review of Aneurysm Cases in Patients with Schistosomiasis

“…In some cases, they occurred in patients with active Schistosoma infection. In these cases, the diagnosis of Schistosoma infection was reached by serological investigations [ 22 ], stool sample assessment, rectal biopsy [ 19 ], and histology of lung [ 17 ] or of liver and testis [ 23 ].…”

“…When we analysed the age at which patients were diagnosed with an aneurysm, we observed that young patients can be affected. The youngest patient included in our review was 18-years old, and overall, five patients were below 40 years [ 13 , 18 , 19 , 22 , 27 ]. This differs from the usual age at diagnosis of atherosclerotic aneurysms and suggests the need for an increased clinical suspicion of aneurysm as differential diagnosis when assessing patients of young age with compatible clinical presentation in endemic areas (Tables 3 and 4 ).…”

“…This leads to increased share stress due to the onset of pulmonary hypertension, right ventricular dilatation, and cor pulmonale [ 17 ]. Schistosome eggs embolization may cause direct damage to the walls of arteries through additional mechanisms, including vasa vasorum obliterative endarteritis, direct endothelium damage, or inducing atheromatic degeneration [ 19 ]. Vanker describes these mechanisms.…”

“…Vanker describes these mechanisms. Eggs of Schistosoma mansoni spread from the left upper lobe of the lung to the adjacent pleura and the aortic thoracic sheath, causing endarteritis obliterans of its vasa vasorum and aneurysm [ 19 ]. Interestingly, this physio-pathological mechanism is shared by other infectious diseases associated with thoracic aortic aneurysms, such as tertiary syphilis [ 28 ].…”