Sonographic features of portal hypertension in Schistosomiasis Mansoni

Pinto-Silva, Rogerio Augusto; Abrantes, Wilson Luiz; Antunes, Carlos Maurício Figueiredo; Lambertucci, Jose Roberto

doi:10.1590/S0036-46651994000400008

Abstracts

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.

Schistosomiasis; Sonography; Splenoportography; Portal Hypertension

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.

SONOGRAPHIC DIAGNOSIS

Sonographic features of portal hypertension in Schistosomiasis Mansoni

Aspectos ultra-sonográfícos da hipertensão portal na Esquistossomose Mansoni

Rogerio Augusto Pinto-Silva^I; Wilson Luiz Abrantes^II; Carlos Maurício Figueiredo Antunes^I; Jose Roberto Lambertucci^I

^IFaculdade de Medicina da UFMG, Belo Horizonte, MG, Brasil

^IIHospital Felicio Rocho

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

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.

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Recebido para publicação em 26/11/1993

Aceito para publicação em 01/06/1994

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.
2. ABRANTES, W.L. - Hipertensăo portal. In: DANI, R. & CASTRO, L.P., ed. Gastroenterologia Clínica. 2. ed. Rio de Janeiro, Guanabara Koogan, 1988. p 983-1000.
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.
4. ATKINSON, M. & SHERLOCK, S. - Intrasplenic pressure as index of portal venous pressure. Lancet, 1: 1325-1327, 1954.
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.
6. BURCHARTH, F.; NIELBO, N. & ANDERSEN, B. - Percutaneous transhepatic portography. II. Comparison with splenoportography in portal hypertension. Amer. J. Roentgenol., 132: 183-185, 1979.
7. CERRI, G.G.; ALVES, V.A.F. & MAGALHĂES, A. - Hepatosplenic schistosomiasis mansoni: ultrasound manifestations. Radiology, 153: 777-780, 1984.
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.
9. COUTINHO, A.D. - Hemodynamic studies of portal hypertension in schistosomiasis. Amer. J. Med., 44: 547-557, 1968.
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.
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.
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.
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.
14. HATZ, C; JENKINS, J.M. & TENNER, M., ed. - Ultrasound in schistosomiasis. Acta trop. (Basel), 51: 1-97, 1992.
15. HILL, M.C.; DACH, J.L. & SHAWKER, T.H. - Ultrasonography in portal hypertension. Clin. Gastroent., 14: 83-104, 1985.
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.
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.
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.
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.
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.
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.
22. RAIA, S.; MIES, S. & MACEDO, A.L. - Portal hypertension in schistosomiasis. Clin. Gastroent., 14: 57-82, 1985.
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.
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.
25. ZOLI, M.; CORDIANI, M.R.; MARCHESINI, G. et al. - Ultrasonographic follow-up of liver cirrhosis. J. clin. Ultrasound, 18: 91-96, 1990.
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.

Endereço para Correspondência:

Dr. José Roberto Lambertucci

Faculdade de Medicina da UFMG

Av. Alfredo Balena, 190

30130-100 - Belo Horizonte, MG, Brasil

Publication Dates

Publication in this collection
20 Sept 2006
Date of issue
Aug 1994

History

Received
26 Nov 1993
Accepted
01 June 1994

This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.

[1] 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.

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

[3] 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.

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

[5] 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.

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

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

[8] 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.

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

[10] 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.

[11] 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.

[12] 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.

[13] 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.

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

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

[16] 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.

[17] 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.

[18] 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.

[19] 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.

[20] 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.

[21] 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.

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

[23] 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.

[24] 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.

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

[26] 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.