Ultrasonography of the liver and spleen in Brazilian patients with hepatosplenic schistosomiasis and cirrhosis

Abstract

Ultrasonography is now widely used in the diagnosis and management of patients with chronic Schistosoma mansoni infections. The present study was undertaken to evaluate the use of ultrasonography in patients with hepatosplenic schistosomiasis (HSS) with and without cirrhosis. Ninety-seven patients (52 males; median age 38 years, range 19–68 years) with HSS, 65 with well compensated (HSSC) and 32 with decompensated (HSSD) disease and cirrhosis, were systematically examined by ultrasound. Hepatic fibrosis was graded according to WHO recommendations. Typical atrophy of the right hepatic lobe accompanied by hypertrophy of the left lobe, with a rounded inferior marginal edge, was seen in 86 (88·7%) patients. Periportal fibrosis was observed in 83 (85·6%) cases and confirmed histologically in all. In 66 patients (68·0%) thickening of the gallbladder wall, associated with periportal fibrosis and extending from the branches of the porta hepatis, was noted. No evidence of biliary disease was found in these patients and gallstones were present in only 3 cases. Fourteen (43·8%) of the HSSD patients could not be classified for grade of fibrosis because of the advanced stage of cirrhosis related to hepatitis B or C viral infection. Of the remaining 18 HSSD patients, none had only grade I fibrosis (vs. 10·8% of HSSC, P = 0·054) and only 6 had grade II (vs. 67·7% of HSSC, P < 0·0005), while the frequency of grade III was significantly higher in the HSSD patients than in those with HSSC (37·5% vs. 21·5%, P = 0·049). These findings indicate that although ultrasonography is a very valid technique for assessing patients with pure HSS, and should be considered the ‘gold standard’, it is not reliable for assessing periportal fibrosis in patients with concomitant cirrhosis due to other causes.