Ultrasonographic diagnosis of schistosomal periportal fibrosis.

Abstract

Hepatosplenic schistosomiasis results from infestation by Schistosoma mansoni, a blood fluke. Presinusoidal periportal fibrosis is invariably the result of this infestation. The ultrasonic pattern of schistosomal periportal fibrosis in 22 patients in whom schistosomal hepatic involvement was proven histologically is described. Echogenic areas of pipestem fibrosis seen as tubular shadows, some containing central lucencies, were present in every case. These tubular shadows conformed to the structure of the portal veins, producing a characteristic appearance. In endemic areas this appearance may be the only clue to the diagnosis of hepatosplenic schistosomiasis, because patients may remain asymptomatic for years after the onset of the disease.

Ultrasound in schistosomiasis mansoni

“…105(4): 479-484, July 2010 Abdel Wahab et al (1979) were the first to report the ultrasound features of hepatosplenic schistosomiasis mansoni. Their findings were confirmed by several investigators in Africa (Fataar et al 1984, Hussain et al 1984 and in Brazil (Cerri et al 1984, Domingues et al 1993, Pinto-Silva et al 1994, 2008. Table I summarises the main findings reported by the above investigators.…”

The chronic enteropathogenic disease schistosomiasis

“…When the tubular structure is viewed crosswise, it appears as a ring of concentric fibrosis surrounding portal venous vasculature, and is known as the 'bull's eye lesion'. [54][55][56] Other US findings include hypertrophy of the left hepatic lobe, atrophy of the right hepatic lobe, gallbladder wall thickening, granulomas, and splenic nodules. The above lesions can also be seen in liver pathology associated with S. japonicum infection.…”

Advances in the Diagnosis of Human Schistosomiasis

“…Since US is a convenient and reliable method, it is routinely used in the diagnosis and evaluation of patients with schistosomiasis (288)(289)(290). US can be used to demonstrate classical features of schistosomal hepatic damage, such as periportal fibrosis, appearing as "bulls-eye" lesions, a network echogenic pattern, hepatic granulomas, and gallbladder thickening (291,292). Furthermore, the use of portable US equipment has widened the applicability of imaging in community field settings in areas where schistosomiasis is endemic.…”