Portal System

In this section on the portal system, illustrations relating to both S. mansoni and S. japonicum (Figs. 2.40 thru 2.57) are grouped in order to facilitate comparison of the radiological appearances of these infections.

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Fig. 2.40 A-F. Hepatomegaly and an often massive splenomegaly is common wherever there is schistosomiasis. A An Egyptian boy with schistosomiasis mansoni, B a Chinese woman with advanced schistosomiasis japonica complicated by ascites, and C a Brazilian boy with schistosomiasis mansoni. D Illustrates the problems in removing the massively enlarged spleen surgically (S. japonicum). E, F Ultrasonography of the spleen in any of these patients would have shown echogenic nodules and enlargement of the splenic veins, as well as the splenomegaly. (E a patient from Zimbabwe; F a patient from Brazil) (A, B AFIP 69-11150-4 and 69-11150-3; E courtesy of Dr. Sam Mindel; F courtesy of Prof. Gharbi, Tunis and Prof. Giovanni Guido Cerri, Sao Paulo).

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Fig. 2.41 A-D. The liver has a very characteristic appearance in schistosomiasis. A The autopsy specimen of a liver of a 27-year-old Brazilian male who died of hematemesis associated with hepatosplenomegaly secondary to schistosomiasis mansoni. There were a total of 183 active adult pairs of worms counted at autopsy. The external surface of the liver is bosselated, which is the typical appearance: sometimes the liver is smooth or finely nodular. B The cut surface of the same liver showing marked periportal fibrosis: the intervening liver parenchyma appears fairly normal. It is possible to have severe disease but show less portal fibrosis. Next to the liver is the edge of the enlarged spleen, which weighed 700g. C, D Cross-sections of the livers of different patients showing the marked periportal fibrosis, septal thickening, and nodular cirrhosis seen in thickening seen in advanced schistosomiasis mansoni or japonica. (C, D AFIP 5426643 and 5427250).

Fig. 2.42 A, B. Periportal fibrosis (or pipe stem fibrosis) is characteristic of hepatic schistosomiasis. A The cut surface of the liver of a patient who died from schistosomiasis mansoni. The periportal fibrosis is due to embolization of eggs from the mesenteric vessels. B The histology of the same liver showing fibrosis involving a periportal triad. The portal vein is on the left and several bile ducts are on the right. (Courtesy of L. Millman, New York City) This periportal fibrosis can be demonstrated by ultrasonography.