Biliary Tract and Pancreas

Calcification may be seen in the main hepatic ducts, the common hepatic, cystic, and common bile ducts, and also the pancreatic duct (Fig. 2.37). Such calcification is tubular and irregular and can be quite dense. There is seldom ductal obstruction, although this has been reported at least once. Biliary and pancreatic ductal calcification is probably a little more common in mixed infections with S. haematobium and S. mansoni and may persist after treatment. Pancreatic calcification (which may occur in S. haematobium infections alone as well as in mixed infections) is not associated with alcohol intake.

The tubular calcification may be seen on plain radiographs and the irregularity in the ducts can be demonstrated by cholangiography. It is well shown by CT as calcified ring densities or, depending on the section, parallel tubular lines.

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Fig. 2.37 A-E. Schistosomal calcification of the appendix, gallblader and pancreas. The eggs of any schistosome can be deposited anywhere, calcified, and become clearly visible on imaging when present in sufficient numbers. Appendiceal calcification is not uncommon, especially with S. haematobium. More than 50% of appendices with histologically proven schistosomiasis will be visible. The gallbladder becomes visible in the same way, and the pancreas presents a more solid mass. A The typical parallel linear pattern of calcified schistosome eggs in the appendix (arrows). B An oblique abdominal radiograph of an Egyptian man known to have urinary schistosomiasis but a lifelong teetotaler (non-alcoholic). There is heavy calcification in the common hepatic duct (arrows), cystic duct (open arrow), and pancreas (curved arrows). C A nonenhanced CT scan of the same patient shows the heavily calcified pancreas, through which the clear pancreatic duct can be seen (black arrows). The cystic duct (curved arrows) and the common hepatic duct (open arrows) are also heavily calcified. D The plain radiograph of a different patient, also an Egyptian male, shows convoluted but serpiginous calcification in the neck of the gallbladder and the cystic duct. The arrow indicates the position of the fundus of the gallbladder. Schistosomal granulomas could be mistaken for calculi both on radiography and ultrasonography. E The CT scan of a different Egyptian patient showing dense calcification in the neck of the gallbladder (arrows). [Courtesy of Dr. S. Fataar, Muscat, and Br J Radiol, 1996 (B, C) and 1990 (D, E)].

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Fig. 2.38 A-C. Schistosomiasis can involve the small bowel, either directly or by adhesions. A Alternate dilatation and contraction of several loops of jejunum, with prominent valvulae conniventes due to mucosal edema, with flocculation and segmentation of the barium. This pattern is often seen in schistosomiasis japonica, resembling malabsorption, but this particular patient was a Puerto Rican with S. mansoni eggs in the stool and on rectal biopsy. (Courtesy of Dr. A. Chait and AJR 1963 and AFIP 68-9019.5) B, C Schistosomiasis mansoni causing a large pericolic bilharzioma and abscess in a 40-year-old Puerto Rican male. The mass is adherent to the descending colon (B, arrows) and to multiple loops of jejunum (C). It involved the mesentery and extended to the anterior abdominal wall. (Courtesy of Dr. Ehrlich, San Juan).