SciELO - Scientific Electronic Library Online

 
vol.36 issue4Current eco-epidemiologic knowledge on pathogenic arbovirus to humans in the Atlantic forest region, State of São Paulo, BrazilChagas' disease in the Brazilian Amazon: I - a short review author indexsubject indexarticles search
Home Pagealphabetic serial listing  

Services on Demand

Article

Indicators

Related links

Share


Revista do Instituto de Medicina Tropical de São Paulo

Print version ISSN 0036-4665

Rev. Inst. Med. trop. S. Paulo vol.36 no.4 São Paulo July/Aug. 1994

http://dx.doi.org/10.1590/S0036-46651994000400008 

SONOGRAPHIC DIAGNOSIS

 

Sonographic features of portal hypertension in Schistosomiasis Mansoni

 

Aspectos ultra-sonográfícos da hipertensão portal na Esquistossomose Mansoni

 

 

Rogerio Augusto Pinto-SilvaI; Wilson Luiz AbrantesII; Carlos Maurício Figueiredo AntunesI; Jose Roberto LambertucciI

IFaculdade de Medicina da UFMG, Belo Horizonte, MG, Brasil
IIHospital Felicio Rocho

Endereço para Correspondência

 

 


SUMMARY

The diagnostic value of real-time sonography in the study of portal hypertension was assessed in 66 patients with hepatosplenic schistosomiasis mansoni, all with Symmers's fibrosis and esophageal varices. Seventy-one individuals without schistosomiasis were selected as controls. The inner diameters of the portal vessels were measured by sonography in all patients and controls: splenoportography was also performed in the schistosomal group. Intra-splenic pressure was over 30 cm of water in 44 of 60 patients with schistosomiasis. The upper limit of normality for portal vessel diameters was set through receiver operating characteristic curve at 12 mm for portal vein, 9 mm for splenic vein at splenic hilus, and 9 mm for superior mesenteric vein. The best discriminative vein for the diagnosis of portal hypertension was the splenic vein followed by the portal vein. A direct correlation was observed between the diameter of the splenic vein, measured by sonography, and the intra-splenic pressure. Except for the paraumbilical and mesenteric veins, more frequently identified by sonography, there was no statistical difference in the frequency of visualization of splanchnic vessels by sonography or splenoportography.

Keywords: Schistosomiasis; Sonography; Splenoportography; Portal Hypertension.


RESUMO

Sessenta e seis pacientes com esquistossomose mansoni hepatoesplênica foram examinados pela ultra-sonografia do abdomen. Trinta e sete também submeteram-se à esplenoportografia. Todos apresentavam fibrose de Symmers e varizes de esôfago. Selecionaram-se setenta e um indivíduos sem esquistossomose como controles. Mediu-se o diâmetro dos vasos porta nos pacientes e controles. A pressão intra-esplênica encontrava-se acima de 30 cm de água em 44 de 60 pacientes com esquistossomose. Os limites superiores da normalidade para os vasos do sistema porta foram definidos como 12 mm para a veia porta, 9 mm para a veia esplênica no hilo e 9 mm para a veia mesentérica superior. O aumento do diâmetro da veia esplênica mostrou-se a alteração mais sensível para o diagnóstico de hipertensão porta, seguido pelo aumento do diâmetro da veia porta. Observou-se correlação direta entre o diâmetro da veia esplênica e da pressão intra-esplênica. Não houve diferença significativa na freqüência de visualização dos vasos esplâncnicos quando se usou a sonografia ou a esplenoportografia, exceto para as veias paraumbilical e mesentérica, mais frequentemente diagnosticadas pela ultra-sonografia.


 

 

Full text available only in PDF format.

Texto completo disponível apenas em PDF.

 

 

REFERENCES

1. ABDEL-WAHAB, M.F. & STRICKLAND, G.T. - Abdominal ultrasonography for assessing morbidity from schistosomiasis. 2. Hospital studies. Trans. roy. Soc. trop. Med. Hyg., 87: 135-137, 1993.         [ Links ]

2. ABRANTES, W.L. - Hipertensão portal. In: DANI, R. & CASTRO, L.P., ed. Gastroenterologia Clínica. 2. ed. Rio de Janeiro, Guanabara Koogan, 1988. p 983-1000.         [ Links ]

3. ANDRADE, Z.A. & CHEEVER, A.W. - Alterations of the intrahepatic vasculature in hepatosplenic schistosomiasis mansoni. Amer. J. trop. Med. Hyg., 20: 425-432, 1971.         [ Links ]

4. ATKINSON, M. & SHERLOCK, S. - Intrasplenic pressure as index of portal venous pressure. Lancet, 1: 1325-1327, 1954.         [ Links ]

5. BOLONDI, L.; GANDOLFI, L.; ARIENTI, V. et al. - Ultrasonography in the diagnosis of portal hypertension: diminished response of portal vessels to respiration. Radiology, 142: 167-172, 1982.         [ Links ]

6. BURCHARTH, F.; NIELBO, N. & ANDERSEN, B. - Percutaneous transhepatic portography. II. Comparison with splenoportography in portal hypertension. Amer. J. Roentgenol., 132: 183-185, 1979.         [ Links ]

7. CERRI, G.G.; ALVES, V.A.F. & MAGALHÃES, A. - Hepatosplenic schistosomiasis mansoni: ultrasound manifestations. Radiology, 153: 777-780, 1984.         [ Links ]

8. CHEEVER, A.W. & ANDRADE, Z.A. - Pathological lesions associated with Schistosoma mansoni infection in man. Trans. roy. Soc. trop. Med. Hyg., 61: 626, 1967.         [ Links ]

9. COUTINHO, A.D. - Hemodynamic studies of portal hypertension in schistosomiasis. Amer. J. Med., 44: 547-557, 1968.         [ Links ]

10. DACH, J.L.; HILL, M.C.; PELAEZ, J.C.; LEPAGE, J.R. & RUSSELL, E. - Sonography of hypertensive portal venous system: correlation with arterial portography. Amer. J. Roentgenol., 137: 511-517, 1981.         [ Links ]

11. DOKMECI, A.K.; KIMURA, K.; MATSUTANI, S. et al. - Collateral veins in portal hypertension: demonstration by sonography. Amer. J. Roentgenol., 137: 1173-1177, 1981.         [ Links ]

12. FOSTER, J.H.; CONKLE, D.M.; CRANE, J.M. & BURKO, H. - Splenoportography. An assessment of its value and risk. Ann. Surg., 5: 773-781, 1974.         [ Links ]

13. HANLEY, J.A. & MCNEILL, B.J. - The meaning and use of the area under a Receiver Operating Characteristic (ROC) curve. Radiology, 143: 29-36, 1982.         [ Links ]

14. HATZ, C; JENKINS, J.M. & TENNER, M., ed. - Ultrasound in schistosomiasis. Acta trop. (Basel), 51: 1-97, 1992.         [ Links ]

15. HILL, M.C.; DACH, J.L. & SHAWKER, T.H. - Ultrasonography in portal hypertension. Clin. Gastroent., 14: 83-104, 1985.         [ Links ]

16. LAMBERTUCCI, J.R.; GRECO, D.B.; PEDROSO, E.R.P. et. al - A double blind trial with oxamniquine in chronic schistosomiasis mansoni. Trans. roy. Soc. trop. Med. Hyg., 76: 751-755, 1982.         [ Links ]

17. NIEDERAU, C.; SONNENBERG, A.; MULLER, J.E. et al. - Sonographic measurements of the normal liver, spleen, pancreas, and portal vein. Radiology, 149: 537-540, 1983.         [ Links ]

18. PANKE, W.F.; BRADLEY, E.G.; MORENO, A.H.; RUZIKA, F.F. & RUSSELO, L.M. - Technique, hazards, and usefulness of percutaneous splenic portography. J. Amer. med. Ass., 169: 1032-1037, 1959.         [ Links ]

19. PINTO-SILVA, R.A. & LAMBERTUCCI, J.R. - The value of ultrasonography in the diagnosis of hepatosplenic schistosomiasis. An. Fac. Med. Univ. Fed. Minas Gerais, 35: 28-38, 1986.         [ Links ]

20. PRATA, A. - Infection with 5. mansoni. In: JORDAN, P. & WEBBE, G., ed. Schistosomiasis: epidemiology, treatment and control. London, William Heinemann Medical Books, 1982. p. 105-227.         [ Links ]

21. PROIETTI, F.A. & ANTUNES, C.M.F. - Sensitivity, specificity and positive predictive value of selected clinical signs and symptoms associated with schistosomiasis mansoni. Int. J. Epidem., 18: 680-683, 1989.         [ Links ]

22. RAIA, S.; MIES, S. & MACEDO, A.L. - Portal hypertension in schistosomiasis. Clin. Gastroent., 14: 57-82, 1985.         [ Links ]

23. SUBRAMANYAM, B.R., BALTHAZAR, E.J., MADAMBA, M.R. et al. - Sonography of portosystemic venous collaterals in portal hypertension. Radiology, 146: 161-166, 1983.         [ Links ]

24. WEILL, F.S. - Cirrhosis and portal hypertension. In: WEILL, F.S., ed. Ultrasonography of digestive diseases. St. Louis, C.V. Mosby, 1982. p. 537-548.         [ Links ]

25. ZOLI, M.; CORDIANI, M.R.; MARCHESINI, G. et al. - Ultrasonographic follow-up of liver cirrhosis. J. clin. Ultrasound, 18: 91-96, 1990.         [ Links ]

26. ZOLI, M.; DONDI, C.; MARCHESINI, G. et al. - Splanchnic vein measurements in patients with liver cirrhosis: a case control study. J. Ultrasound Med., 4: 641-646, 1985.         [ Links ]

 

 

Endereço para Correspondência:
Dr. José Roberto Lambertucci
Faculdade de Medicina da UFMG
Av. Alfredo Balena, 190
30130-100 - Belo Horizonte, MG, Brasil

Recebido para publicação em 26/11/1993
Aceito para publicação em 01/06/1994