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 around the world, 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 Schistosoma mansoni infection hastens the  dysplastic changes within the liver parenchyma in the presence of other risk factors ( a common association between HCV andSchistosoma mansoni infection is noticed in our patients in Egypt) and hepatocellular carcinoma (HCC) ocuurs early and with a more aggressive and infiltrative nature, compared to the same risk in patients with HCV with no schistosomiasis.