Abstract
BackgroundPortal hypertension is responsible for various complications in patients with schistosomiasis, among them intrapulmonary vascular dilations (IPVD). In cirrhotic patients the presence of IPVD is a sign of poor prognosis, but in patients with hepatosplenic schistosomiasis (HSS) there are no studies assessing the significance of this change. The aim of this study was to evaluate the occurrence of IPVD through 99mTc-MAA scintigraphy in patients with HSS and its relationship with clinical, laboratory, endoscopic and ultrasound parameters.MethodsCross-sectional study evaluating 51 patients with HSS. Patients were diagnosed with IPVD when the brain uptake of 99mTc-MAA was higher than 6%. Subsequently, they were divided according to presence (G1) or absence (G2) of IPVD and variables were compared between groups.ResultsOverall, 51 patients with mean age of 56±12 years were assessed. IPVD was observed in 31 patients (60%). There was no statistically significant differences between groups when clinical, laboratory and endoscopic parameters were compared. Regarding ultrasound parameters, the splenic vein diameter was smaller in G1 (0.9±0.3 cm) compared to G2 (1.2±0.4 cm), p = 0.029.ConclusionIn patients with HSS, the occurrence of IPVD by 99mTc-MAA scintigraphy was high and was associated with lower splenic vein diameter, which can be a mechanism of vascular protection against portal hypertension. However, more studies are needed to determine the clinical significance of the early diagnosis and natural evolution of IPVD in this population.
Highlights
Hepatosplenic schistosomiasis (HSS) is characterized by the presence of liver fibrosis around the intrahepatic branches of the portal vein without damage to the hepatocyte synthesis ability [1]
It is estimated that schistosomiasis affects 2.5–6 million Brazilians [2] and about 10% of them develop the hepatosplenic form, which is the main cause of portal hypertension in Northeastern Brazil [3]
Portal hypertension is responsible for a number of complications in patients with schistosomiasis, like esophageal varices, gastrointestinal bleeding or intrapulmonary vascular dilatation (IPVD) [4,5]
Summary
Hepatosplenic schistosomiasis (HSS) is characterized by the presence of liver fibrosis around the intrahepatic branches of the portal vein without damage to the hepatocyte synthesis ability [1]. Portal hypertension is responsible for a number of complications in patients with schistosomiasis, like esophageal varices, gastrointestinal bleeding or intrapulmonary vascular dilatation (IPVD) [4,5]. IPVD is the key event in the development of hepatopulmonary syndrome (HPS), when associated with alveolar-arterial difference of O2 .15 mmHg and liver disease with portal hypertension [6]. The presence of IPVD is evidence of poor prognosis, especially when associated to HPS [4], but in HSS patients, there are no studies assessing the clinical significance and prognosis. Portal hypertension is responsible for various complications in patients with schistosomiasis, among them intrapulmonary vascular dilations (IPVD). In cirrhotic patients the presence of IPVD is a sign of poor prognosis, but in patients with hepatosplenic schistosomiasis (HSS) there are no studies assessing the significance of this change. The aim of this study was to evaluate the occurrence of IPVD through 99mTc-MAA scintigraphy in patients with HSS and its relationship with clinical, laboratory, endoscopic and ultrasound parameters
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