Peripheral atrophy/central hypertrophy complex in chronic hepatic Schistosoma mansoni infection with histological correlation

Abstract

Objective Peripheral atrophy/central hypertrophy (PACH) complex has been described in various chronic liver diseases but never in chronic hepatic Schistosoma mansoni infection. This study describes the imaging and anatomic features of PACH complex in four patients using high resolution cross-sectional imaging with 3D reconstructions and pathologic correlation. Materials and methods Two radiologists assessed imaging studies from four patients with proven chronic hepatic S. mansoni infections for presence of PACH complex, hepatic surface lobulations, capsular thickening, periportal fibrosis, hepatic calcification, gallbladder wall enhancement and thickening, and splenomegaly. 3D volume rendering and curved planar and oblique reformation in the planes of the hepatic veins were performed to better evaluate the 3D position of the hepatic veins relative to the liver parenchyma and capsule. Results All four patients had PACH complex and hepatic surface lobulations. 3D volume rendered images demonstrated severe peripheral atrophy with migration of hepatic veins on the capsular surface of the liver. Multiplanar reconstruction demonstrated coexisting hypertrophy about the central portal veins and atrophy of the peripheral liver parenchyma with thinned or no parenchyma between the hepatic veins and the liver capsule. All patients also had capsular thickening, splenomegaly, and no calcifications. While all patients had enhancement of the gallbladder wall in the arterial phase without thickening, three patients had dilated veins on the surface of the gallbladder wall. Three patients also had periportal fibrosis. Conclusion This study is the first to report PACH complex in chronic hepatic S. mansoni infection. Atrophy results in crowding of smaller hepatic veins in the periphery of the liver. Finally, hepatic capsular thickening on imaging is a further sign of this infection.