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Schistosomiasis Mansoni

The main imaging findings in S. mansoni infections reflect the pathological changes in the bowel, portal system, and lungs.

Large Bowel

The earliest radiographic changes in the colon include an edematous mucosal pattern with mural spiculations or tiny ulcers, often accompanied by spasm and incomplete distention of the involved segment (Fig. 2.30).



Fig. 2.30 A-D. The early changes of schistosomiasis mansoni of the colon. A Because there are many tiny punctate mucosal ulcerations, a double contrast barium enema will show a fine granular mucosa, as in this hepatic flexure. There is local spasm, making it difficult to distend the colon completely. B The marked inflammatory cell reaction surrounding eggs of S. mansoni in the submucosa of the rectum. X100; AFIP 53-8656. C The terminal ileum and right hemicolon (after partial evacuation of a barium enema). The terminal ileum is normal, except for slight external pressure due to a granulomatous mass in the pericecal and appendiceal tissues. The cecum is irregular and spiculated and there is considerable spasm in the ascending colon. The clinical diagnosis was acute appendicitis, but the cecum was found to be encased in a 0.5-cm-thick fibrous wall, which extended to involve the ascending colon and around the appendix. Histologically there were multiple schistosome eggs and granulomas and an intense serosal eosinophilic granulomatous exudate in the pericecal fat, possibly due to the recent death of the adult female schistosome outside the cecum. Rectal biopsy was also positive for S. mansoni eggs. D Edema of the mucosa, associated with irregularity and spasm. A previous rectal biopsy had shown schistosome eggs. All these patients were Puerto Ricans living in New York. (A was a 19-year-old male, C a 42-year-old male, and D a 37-year-old female). All had a chronic history of abdominal pain, diarrhea, and weight loss.

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