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Fig. 2.46 A-E. In schistosomiasis japonica the eggs are frequently deposited along the fibrous septa of the liver with only a mild inflammatory response. The eggs are more common in the peripheral or subcapsular regions, but in some patients are more dense along the central portal tract, resembling the pattern of schistosomiasis mansoni. A Many eggs of S. japonicum in the septa, with minimal surrounding inflammatory or fibrotic reaction. x32, AFIP 55-7781. B-D The eggs of S. japonicum clustered along the septa in the liver of an 82-year-old Japanese patient. Stained with H&E: B is taken from A with increased magnification. In C azan staining has been used to show the fibrous tissue in the septa of the same liver. (Courtesy of Dr. S. Monzawa, Yamanashi) E Linear calcification, both thick and thin lines, seen on the CT scan of a patient from China. (Courtesy of Prof. Xing-Rong Chen, Shanghai).

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Fig. 2.47 A-F. Scans from Hong Kong, showing (A) echogenic lines on ultrasonography and (B) the same calcified septal lines on CT. MRI is not always as useful as CT. MRI is not always as useful as CT or ultrasonography and the septa may be poorly demonstrated. The (C) ultrasound and (D-F) T1, T2, and postgadolinium MRI sequences at approximately the same level, in another Chinese patient from Hong Kong. (All scans courtesy of Dr. H. Cheung, Hong Kong).

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Fig. 2.48 A-F. Schistosomiasis japonica may cause little clinical evidence of liver damage (unless there is coexistent hepatitis B infection). A, B Fibrosis in which there are schistosome eggs results in echogenic branching septa separating relatively normal lobules on ultrasonography: A a Japanese female (arrows indicate septa) and B a Chinese male. C-F In the early stages CT scanning may need contrast enhancement to show the septa clearly. C Nonenhanced CT of a 55-year-old Japanese male does not show any abnormality but (D) contrast-enhanced CT shows linear enhancement (arrows). E Nonenhanced CT in a patient from Hong Kong shows septal calcification close to the top of the liver, better seen with contrast enhancement. F Similar pre- and postenhancement scans of a 77-year-old Japanese patient known to have had a positive stool examination for S. japonicum 54 years previously. The faint linear density seen on the nonenhanced CT (arrow) is much more clearly seen after enhancement (arrowhead). (A, C, D, F courtesy of Dr. S. Monzawa, Yamanashi; B, E courtesy of Dr. H. Cheung, Hong Kong).

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Fig. 2.49 A-D. CT and MRI scans of a 61-year-old Japanese patient with histologically proven schistosomiasis japonica. A CT shows two linear, calcified septal lines (arrows). B On T 1-weighted MRI, only the anterior line is seen (arrow), at low intensity. After gadolinium-DPTA (C) both lines are again seen (arrows) and are slightly enhanced. On T-2 weighted MRI (D) the posterior line cannot be identified (arrow indicates anterior line). (Courtesy of Dr. S. Monzawa, Yamanashi).