Presentation
Follow-up for a known case of hepatic schistosomiasis.
Patient Data
irregular surface of the liver
hyperechoic thickened walls of portal venules give the "clay-pipestem" pattern of periportal fibrosis
marked thickening and echogenicity of the gallbladder bed
splenomegaly
portal vein and splenic vein dilatation with maintained continuous hepatopetal flow and average velocity
Case Discussion
The above-described sonographic findings are consistent with the patient's history of hepatic schistosomiasis and subsequent portal hypertension and splenomegaly. Although this entity is not usually encountered by physicians worldwide, it's known to be endemic in Egypt due to the country's dam and irrigation projects along the river Nile. It's caused mainly by Schistosoma mansoni, and it causes the described picture by inflammation and fibrosis around the embolized eggs of the worm.
Recent studies show that S. mansoni infection hastens the dysplastic changes within the liver parenchyma in the presence of other risk factors (a common association between HCV and S. mansoni infection is noticed in our patients in Egypt). Hepatocellular carcinoma (HCC) occurs early and with a more aggressive and infiltrative nature, compared to the same risk in patients with HCV with no schistosomiasis.
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