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Fig. 2.50 A-F. When the lobular calcification becomes extensive, the lobules become more clearly outlined and the characteristic pattern develops; this has been variously described as resembling a turtle or tortoise shell, a mosiac, or fish scales. The intervening liver parenchyma may still appear relatively normal. A Nonenhanced CT scan of a 79-year-old Japanese male with S. japonicum in his stool. B The cut section of a similar liver. AFIP 54-2663-5. C, D CT scans at different levels in a patient from China, showing an extensive calcified network. E Septal calcification with junctional thickening (notches), enhancing strongly with contrast. There is also capsular calcification. F An axial sonogram through the liver of a patient from Hong Kong with schistsomiasis japonica showing the same network-mosaic pattern. (E, F courtesy of Dr. H. Cheung, Hong Kong; F courtesy also of Clin Radiol, 1996).

Fig. 2.51 A-C. Capsular calcification in S. japonicum infection can be quite dense, with or without septal calcification. A Calcification along the lateral aspect of the liver (arrows) seen on nonenhanced CT scan in a 65-year-old Japanese male with histologically proven schistosomiasis japonica. There is very little septal calcification. B, C Capsular and septal calcification in two patients from China, both with schistosomiasis japonica. (Courtesy of Prof. Xing-Rong Chen, Shanghai.

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Fig. 2.52 A-F. Schistosomiasis japonica can also cause vascular calcification. A A CT scan showing calcification in the portal vein of a patient from China. B Another Chinese patient with calcification in both the portal and splenic veins. C Calcification in the wall of the superior mesenteric vein. Both B and C, and also D, show a decrease in size of the right lobe of the liver and some enlargement of the left lobe. This may be a little more common in S. japonicum infections in China than elsewhere. (A-D courtesy of Prof. Xing-Rong Chen, Shanghai). S. haematobium infections have not been reported as a cause of vascular calcification, but ultrasonography (or CT) may show thrombosis, as in these sonograms (E) of the superior mesenteric vein and (F) the portal vein of Africans from Zimbabwe. (Courtesy of Dr. Sam Mindel).

Fig. 2.53 A,B. In some patients with schistosomiasis japonica there may be focal liver lesions which resemble a tumor. A A localized hypoattenuating lesion with incomplete rim calcification which showed heterogenous peripheral enhancement with contrast-enhanced CT, thought to represent a hepatoma. Biopsy showed S. japonicum eggs and increased liver iron. Such masses can also be mstaken for metastases. (Courtesy of Dr. H. Cheung, Hong Kong and Clin Radiol, 1996) There also seems to be a link between schistosomiasis japonica with hepatitis B infection and malignancy. B A hepatoma associated with the lobular pattern of schistosomiasis. (Courtesy of Prof. Xing-Rong Chen, Shanghai).