Biomedical subjects
Publications and source records attributed to S Fataar.
Schistosomiasis is one of the commonest parasitic diseases affecting mankind. Egyptian schistosomiasis (mansoni and haematobium) is capable of producing fibrosis and/or calcification, resulting in striking radiological features in target organs. Our two cases with biliary and pancreatic calcification provide a combination of features not documented previously.
Calcification of the ureters, bladder and seminal vesicles was detected in six patients studied on computed tomography (CT) for evaluation of genitourinary schistosomiasis and in four others examined for intestinal schistosomiasis. Other findings included pyelocaliectasis in ten kidneys, vesical carcinoma in one, seminal vesicle granuloma in one and non-visceral calcification in pelvic tissue in one patient.
In 18 patients, 27 of thirty two pseudocysts were successfully drained percutaneously. The first 26 were drained directly and the last six drained transgastrically. Failures resulted from tube blockage by necrotic phlegmon in three and pancreatico-cutaneous fistulation in two with obstructed pancreatic ducts. Transgastric drainage is preferred as it appears to prevent chronic pancreatico-cutaneous fistula formation.
Schistosomiasis in its many forms still presents a major public health challenge. Its tendency to cause dystrophic calcification makes it ideal for radiologic study. With population movement the disease may be encountered in unexpected countries especially with the sensitivity of CT to the presence of calcium. S. japonica produces pathognomonic "turtleback" calcification in the liver, in association with hepatic fibrosis but not necessarily cirrhosis. This paper illustrates a classic case and reviews the literature.
Radiologically controlled catheter drainage is now accepted therapy for fluid collections in many parts of the body. While this is performed mainly in the abdomen, the chest is increasingly being drained percutaneously as an alternative to surgical drainage (van Sonnenberg et al 1984; Westcott 1985; O'Moore et al 1987; Crouch et al 1987). This report outlines the experience with 31 chest collections treated by the intervention radiologist over a two-year period.
In four out of six gallbladders with schistosomal infestation, calcified granulomas were dense enough to be seen on abdominal radiographs. In one patient, faint calcification seen on a specimen of the excised gallbladder was not visible on the abdominal radiograph. Calcification on abdominal radiographs, especially serpiginous, seen in the region of the neck of gallbladder, appears to be the clue to the diagnosis of gallbladder schistosomiasis in people from endemic areas.
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Six patients had strictures of the right colon not causing clinical obstruction. The strictures did not fill during barium enema tests resulting in the 'amputated' proximal right colon mimicking the caecum and/or terminal ileum. Positive caecal identification relies on terminal ileal and appendiceal filling. In 4 patients, a barium follow-through study, performed immediately after a barium enema allowed quick and safe identification of a proximal colonic stricture.
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In a 6-month period, 25 appendices with histological involvement by schistosomiasis were radiographed. Eleven showed varying degrees of radiographically detectable calcification having a spotty, linear, or amorphous pattern affecting either a short segment or the whole appendix. Four of these appendices had a mixed pattern and one also had nodular calcification in the mesoappendix. In only 1 patient was the appendiceal calcification visible on preoperative abdominal radiographs. In 5 asymptomatic patients, not submitted to surgery, appendiceal calcification was detected during radiologic evaluation of urinary schistosomiasis.
The radiological and clinical features of 9 cases of obstructed post-traumatic diaphragmatic hernia are reviewed. In none of these patients was the diagnosis of a diaphragmatic hernia considered before radiography, all cases being clinically diagnosed as 'acute abdomen', most frequently pancreatitis or perforated peptic ulcer. Even after radiographs had shown opacity at the left base in all 9 cases, together with a distended proximal bowel in 6, the correct diagnosis was made in only 4. Through lack of correct radiological diagnosis, there was a delay of at least 1 day between admission and operation in 6 patients, and 3 of the 4 deaths occurred in this group. Obstruction-strangulation of diaphragmatic hernia should be considered as a possible cause of 'acute abdomen' in the presence of a left basal abnormality, especially in patients from areas with a high incidence of assault. Confirmatory contrast studies should be done only if they can be done immediately and quickly. Pregnancy can cause hernias to become obstructed and strangulated, but this can be averted by obtaining a history of previous trauma early in the pregnancy.
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Schistosomal periportal fibrosis produced a typical pattern on computed tomography in five patients. Low-density periportal tissue, present throughout the liver, enhanced strongly after the administration of contrast medium. While rounded in cross section, the thickened periportal tissue produced linear and branching patterns when imaged in longitudinal section. In all cases, the sonographic features were typical of schistosomal periportal fibrosis. A lack of awareness of the distinctive features of periportal fibrosis may result in a mistaken diagnosis of hepatic metastases.
Four patients who had intravenous pyelography were found to have radiologically visible calcification of the rectocolon and urinary tract due to schistosomiasis. All four patients had mild proctocolitis colonoscopically and multiple calcified schistosomal ova were found in the submucosa histologically. The authors believe that radiologically visible rectocolonic calcification is more common than reported and that it is associated with a clinically mild or latent form of schistosomiasis.
Rectocolonic calcification was detected radiographically in 17 sites in 14 patients undergoing excretory urography for the assessment of urinary schistosomiasis. The right colon was involved in 11 sites, the rectum in four, and the left colon in two. The pattern of calcification varied according to the degree of bowel distension. A laminar pattern was common to all sites and occurred when the rectum or colon was distended with air, feces, or barium. A laminar or irregular amorphous density was found in the empty colon, whereas the calcified, empty rectum had a corrugated pattern. Rectocolonic calcification is probably the most common radiographic manifestation of schistosomal infestation of the gastrointestinal tract.
The hepatic sonograms of 22 patients with the features of schistosomal periportal fibrosis (PPF) were reviewed retrospectively. Dense echogenic bands were seen when scanning along the long axis of the intrahepatic portal vein radicles. Rounded densities resulted from scanning across these bands as they radiated from the porta hepatis to the liver's edge. Scanning across central and peripheral bifurcation points of the portal veins produced a branching pattern of high echogenicity. Associated findings were ascites and splenomegaly secondary to the liver disease. The hepatic sonographic features were characteristic of portal tract thickening from schistosomal PPF.