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Fig. 2.43 A-L. The characteristic periportal fibrosis of hepatic cirrhosis due to S. mansoni infections can be demonstrated by both ultrasonography and CT scanning. Both will show the dense bands which follow the portal vein branches into the periphery of the liver. On ultrasonography the bands are echogenic, while on CT they are of low density but enhance strongly with contrast, becoming either homogenous or denser than the surrounding liver. Depending on the angle, the foci can be round or linear and the branching pattern allows differentation from metastases. A Transverse ultrasound scans of the left lobe of the liver of an African from Kenya, showing well-marked periportal fibrosis due to S. mansoni. (Courtesy of WHO and Dr. M.W. Wachira) B, C Similar periportal fibrosis in an African from Zimbabwe. (Courtesy of S. Mindel) D-H A middle-aged Egyptian male who had splenectomy 2 years earlier for portal hypertension. D Transverse sonongram showing thick echogenic circles surrounding the portal vein branches. E, F Nonenhanced CT scans show both round and linear patterns of low density throughout the liver. G In the early phase of contrast scanning, the inferior vena cava has just filled, and there is compression of the left main portal vein. H One minute later there is contrast enhancement of both the linear and circular zones: this pattern persists for several minutes. I-L The same pattern in a younger Egyptian male who had severe hematemesis due to esophageal varices. There is the same typical appearance of periportal fibrosis on ultrasonography (I), nonenhanced CT scan (J), the early contrast phase (K), and four minutes later (L). The CT scans of J and K are at the same level. (D-K courtesy of Dr. S. Fataar, Muscat and AJR, 1985).

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Fig. 2.44. A Cross-section of human liver showing adult male and female S. mansoni in a small liver abscess. x50, AFIP 65-3024. B Multiple schistosome eggs in a different liver have caused an intense fibrosis and hepatic cell destruction. AFIP 68-4761. C A single S. mansoni egg in a liver sinusoid surrounded by minimal inflammatory reaction. x54. D Magnification of the same S. mansoni egg, showing the lateral spine. x270, AFIP 67-4754 and 67-4753.

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Fig. 2.45 A-D. Schistosome granulomas in the liver cause a marked inflammatory reaction and eventually fibrosis. A S. mansoni eggs within granulomas, surrounded by intense small cell inflammatory reaction. B S. japonicum eggs in several liver granulomas with intense surrounding fibrosis. C Intense hepatic fibrosis around several granulomas with virtually no recognizable liver cells remaining. D If there are sufficient eggs surrounding these granulomas, there may be a pattern of dense nodules (spots), as seen in this patient from Hong Kong with schistosomiasis japonica. There is also septal and capsular calcification ( see Figs. 2.43-2.47). (D courtesy of Dr. H. Cheung, Hong Kong).