Correct answer is:
Thick and echogenic bands surrounding the portal vessels and gallbladder. – Schistosomiasis (hepatosplenic form)
Explanation:
Schistosomiasis is an important health problem in underdeveloped countries, especially in South America. The case represents a hepatosplenic form of this disease. The main findings in this presentation are thick and echogenic bands around the portal vessels and the gallbladder. Splenomegaly is highly prevalent in these patients, often with siderotic nodules. The rate of blood flow in the portal vein is usually normal (>16 cm/s) in the early stages of the disease.
In cirrhosis the main signs are nodulated liver surface, parenchymal disorganization, caudate lobe hypertrophy and portal hypertension with low blood flow speeds in the portal vein, typically <15 cm/s.1,2,3
Take home message:
Although ultrasound findings must be associated with epidemiologic information for best accuracy, in a liver marked by periportal thickening, especially if associated with pronounced splenomegaly, schistosomiasis must be remembered in the differential diagnoses of liver diseases. Special attention must be taken to the thick and echogenic bands surrounding the portal vessels and the gallbladder.
References
- Azevedo, LM; Queroz LC; Santo, MCCE; Chammas, MC. Aspectos ultrassonográficos e hemodinâmicos da esquitossomose mansônica: avaliação pela ultrassonografia Doppler em áreas endêmicas. Radiologia Brasileira, vol.43 nº2-Mar/Abr 2010
- Hatz C, Jenkins JM, Ali QM, Abdel- Wahab MF, Cerri GG, Tanner M. A review of the literature on the use of ultrasonography in schistosomiasis with special reference to its use in field studies. 2. Schistosoma mansoni. Acta Trop 1992;51:15¾28CH, Dickman K, Tisch DJ. Reassessment of the cost of chronic helmintic infection: a meta-analysis of disability-related outcomes in endemic schistosomiasis. Lancet 2005; 365:1561.
- Meurs L, Mbow M, Vereecken K, et al. Epidemiology of mixed Schistosoma mansoni and Schistosoma haematobium infections in northern Senegal. Int J Parasitol 2012; 42:305.
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