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We present a case of a patient with hypersplenism secondary to portal hypertension due to hepato-splenic schistosomiasis, which was accompanied by severe and refractory thrombocytopenia. We performed spleen ablation and measured the total spleen and ablated volumes with contrast-enhanced computed tomography and volumetry. No major complications occurred, thrombocytopenia was resolved, and platelet levels remained stable, which allowed for early treatment of the patient's underlying disease. Previous work has shown that splenic radiofrequency ablation is an attractive alternative treatment for hypersplenism induced by liver cirrhosis. We aimed to contribute to the currently sparse literature evaluating the role of radiofrequency ablation (RFA) in the management of hypersplenism. We conclude that splenic RFA appears to be a viable and promising option for the treatment of hypersplenism.

The aim of this study was to compare portal and splenic blood flows and the liver morphology in hepatosplenic (HS) and hepatointestinal (HI) schistosomiasis. Doppler ultrasound measurements were performed in 48 adult patients with schistosomiasis, according to the criteria of the World Health Organization, and compared with those performed in 20 healthy controls. Portal flow was significantly higher (P < 0.0001) in both HS and HI (2481 +/- 1467 and 2159 +/- 1446 ml/min, respectively) than in normal individuals (842 +/- 322 ml/min). There was no difference in splenic blood flow (822 +/- 685 and 458 +/- 292 ml/min, respectively) between HS and HI, but these values were significantly higher than those of normal controls (243 +/- 94 ml/min). Portal and splenic overflow are found in both the HS and the HI forms of schistosomiasis.

Background: The distal splenorenal anastomosis (Warren's operation) has been indicated for the treatment of high digestive bleeding caused by esophagic varices because it would ideally reduce the venous pressure in the cardiotuberositary territory without changing the mesenteric-portal venous flow. However, the changes it produce in the splenic territory have not been fully understood., Aim: To appraise the late morphologic and hemodynamic changes in the splenic territory produced by the distal splenorenal anastomosis in patients with portal hypertension due to mansoni's hepatosplenic schistosomiasis complicated by esophagic bleeding., Method: Ultrasonography-Doppler study of the splenic region of 52 patients with portal hypertension due to mansoni's schistosomiasis and previous bleeding by esophagic varices. They were divided in two groups: 40 non operated upon and 12 with a distal splenorerenal anastomosis. The following parameters and indices were compared between the two groups: a) morphometric parameters (splenic artery and vein's diameter, splenic diameters (longitudinal, transversal and antero-posterior); b) velocimetric parameters of the splenic vessels (systolic peak velocity in the splenic artery, mean flow velocity in the splenic vein; c) biometric index of the spleen (longitudinal x transversal); volumetric index of the spleen (longitudinal x transversal x antero-posterior x 0,523); hemodynamic indices of the splenic artery's impedance: pulsatility and resistivity., Results: The patients with distal splenorenal anastomosis showed: a) reduction in splenic indices: volumetric (non operated 903,83 +/- 452, 77 cm / distal splenorenal anastomosis 482,32 +/- 208,02 cm (46,64%)) and biometric (non operated 138,14 +/- 51,89 cm /distal splenorenal anastomosis 94,83 +/- 39,83 cm (33,35%)); b) no change: splenic artery's diameter (non operated 0,57 +/- 0,16 cm/distal splenorenal anastomosis 0,57 +/- 0,23 cm); velocity in the splenic artery non operated 107 +/- 42,02 cm/seg/distal splenorenal anastomosis 89,81 +/- 41,20 cm/seg), resistivity (non operated 0,58 +/- 0,008/distal splenorenal anastomosis 0,56 +/- 0,06) and pulsatility (non operated 0,91 +/- 0,19/distal splenorenal anastomosis 0,86 +/- 0,15, splenic vein (non operated 1,10 +/- 0,30 cm/distal splenorenal anastomosis 1,19 +/- 0,29 cm); c) increase: mean flow velocity in the splenic vein (non operated 20,54 +/- 8,45 cm/seg/distal splenorenal anastomosis 27,83 +/- 9,29 cm/seg)., Conclusions: The comparison of the ultrasonography Doppler results of the two groups of patient (non operated and distal splenorenal anastomosis) showed that in patients with distal splenorenal anastomosis there was a decrease of the volume of spleen; increase in the mean flow velocity in the splenic vein; no changes in the morphologic and hemodinamyc parameters of the splenic artery neither in its velocimetric indices.

Background: The hemodynamical effect of the collateral portosystemic circulation upon the portal system has not yet been fully understood. The US-Doppler made possible the non-invasive study of the portal system by evaluating the parameters: flow direction, diameter and flow velocity in it's vessels., Aims: To study the paraumbilical vein as a collateral portosystemic pathway and identify patterns for appraising its hemodynamic importance to the portal system., Method: US-Doppler study of the portal system of 24 patients with Mansoni's hepatosplenic schistosomic portal hypertension, previous esophagic variceal bleeding and patent paraumbilical vein with hepatofugal flow. The diameter and the mean flow velocity were measured in the paraumbilical vein and so were the mean flow velocity in the portal vein, right and left portal branches. The Pearson test (linear correlation) was applied to the portal vein's mean flow velocity and the paraumbilical vein's diameter and mean flow velocity. The patients were divided in four groups: D1-paraumbilical vein with diameter < 0.68 cm (n = 14), D2-paraumbilical vein with diameter > or = 0.68 cm (n = 10), V1-paraumbilical vein with mean flow velocity < 18.41 cm/seg (n = 13) and V2-paraumbilical vein with mean flow velocity > or = 18.41 cm/seg (n = 11). The mean flow velocity in the portal vein, right and left portal branches of the four groups were compared., Results: The paraumbilical vein diameter was 0.68 +/- 0.33 cm (range: 0.15-1.30 cm) and the mean flow velocity was 18.41 +/- 11.51 cm/seg (range: 5.73-38.20 cm/seg). The linear correlation between the portal vein's mean flow velocity/paraumbilical vein diameter and the paraumbilical vein's mean flow velocity showed r = 0.504 and r = 0.735, respectively. In the group D2 there was an increase in the mean flow velocity in the portal vein (17.80 +/- 3.42/22.30 +/- 7.67 cm/seg) and in the left portal branch (16.00 +/- 4.73/22.40 +/- 7.90 cm/seg). In the group V2 there was an increase in the mean flow velocity in the portal vein (16.31 +/- 3.49/21.96 +/- 5.89 cm/seg) and in the left portal branch (14.22 +/- 4.41/21.94 +/- 7.20 cm/seg). There was no change in the right portal branch (13.67 +/- 5.74/15.43 +/- 3.43 cm/seg)., Conclusions: In portal hypertension due to hepatosplenic schistosomiasis, the patent paraumbilical vein, with hepatofugal flow, diameter > or = 0.68 cm and mean flow velocity > or = 18.41 cm/seg causes an increase of the mean flow velocity in the portal vein and left portal branch. The best US-Doppler parameter to appraise the paraumbilical vein influence upon the portal system is the mean flow velocity. The correlation between the increase in portal vein's mean flow velocity is stronger with the paraumbilical vein's mean flow velocity than with its diameter. The increase in the portal vein's and left portal branch's mean flow velocity may be understood as the paraumbilical vein's hemodynamic influence upon the portal system. An active portosystemic collateral pathway increases the mean flow velocity in the vein's segment proximal to its point of origin.

The authors comment upon the importance of the hepatic wedged venous pressure for the appraisal of the circulatory conditions of the portal system, mainly in cirrhotic patients. Wondering about the irregular results obtained in the study of schistosomotic portal hypertensive patients by occlusive catheterization and with the use of an occlusive balloon catheter, noted the scarcity of angiographic studies on the subject in this pathology. Present the angiographic aspects that were obtained from patients with schistosomotic portal hypertension complicated by digestive bleeding, by means of injecting the contrast material into a hepatic vein of the right hepatic lobe via a loosely introduced catheter. Those radiological aspects were distributed in two categories: 1) type I-presenting variable sinusoidal filling. Presence of anastomotic intraparenquimatous communications with or without calibrous anastomotic veins between the hepatic veins, 2) type II-presenting no sinusoidal filling. Presence of multiple anastomotic communications of varied calibers between the hepatic veins. Commenting the difficulty of assessing the wedged pressure in patients with schistosomotic portal hypertension because of the easy communication between the hepatic veins, the authors point out that the measured pressure, in all the cases, will be that of the opposite hepatic vein. That pressure, in this pathology, might represent the sinusoidal resistance (when present) between hepatic veins, instead of relating to the portal vein. Suggestion is made that the measure of the wedged hepatic pressure, in patients with schistosomotic portal hypertension, be appraised considering the angiographic aspects of the hepatic veins.

Background/aims: The purpose of this study was to describe the echographic features of Ascaris lumbricoides invasion of the alimentary tract, biliary system, liver and pancreas., Methodology: We studied 38 patients with roundworm heavy infection whose diagnosis were primarily supported by ultrasonographic examination., Results: Thirty-seven patients were admitted with the following clinical complications: bowel obstruction, intra and extrahepatic dilatation, acute cholecystitis, intrahepatic abscess, acute appendicitis, subphrenic collection and acute pancreatitis. Ultrasound scanning was able to recognize in 30 cases the echogenic, nonshadowing images of the worms as single or multiple strips; in 8 cases, coiled structures and amorphous material were detected. The "inner tube" sign was considered as the most specific one. In two cases the roundworms were displayed within the stomach, a curious finding, up to now never reported in medical literature., Conclusions: Real-time sonography represents an efficient, reliable and non-invasive diagnostic approach for hepatobiliary, enteric and pancreatic ascariasis.

This review presents an outline of the pathology resulting from Schistosoma mansoni infections, and the ways in which it can be investigated. The use of ultrasonography is covered in detail. Ultrasonography can provide direct information about lesions in internal organs, and thus provide information about patterns of morbidity and about the regression of pathological changes after treatment. The method is non-invasive, and can be used under field conditions. Ultrasonography is valuable for the study of hepatosplenic pathology, to detect lesions such as the development of periportal fibrosis and the enlargement of the portal vein, which can indicate the development of portal hypertension. This may lead to a severe outcome, including bleeding from oesophageal varices, which is a principal cause of death from S. mansoni infection. A problem with the use of ultrasonography is that the mild lesions likely to be observed in population surveys are not always easy to assess. Ultrasonography has already been used in a number of epidemiological studies of S. mansoni infection, and has proved to be feasible and useful. However, the methodology used for ultrasound studies has varied considerably, so that it is difficult to make valid comparisons between results obtained in different places or at different times. A standardized methodology for making observations and recording the results is needed if the full potential benefit of using ultrasound in the monitoring of schistosomiasis control projects is to be realised.

Conventional ultrasonography highly contributes to a non invasive diagnosis of HS schistosomiasis (Cerri et al., 1984). The introduction of Doppler allowed new advances in the knowledge of the portal dynamics of this disease (Taylor et al. 1985; Moriyasu et al., 1986). The aim of this paper was to analyze the hemodynamic behavior of the portal vessels, considering caliper, maximum flow speed, direction of flow and preferential disposition of the collateral vessels. Thirty two patients with schistosomiasis mansoni with confirmed hepatosplenic form (HSSM), were analyzed. Fourteen patients with the intestinal form, have been analyzed as a control group. The results demonstrated that the maximum speed of the portal vein in the two groups has not been significantly different. Nevertheless, the diameter of the PV in the hepatosplenic group has been larger. The splenic vein presented speed and caliper larger than the superior mesenteric vein. The hepatic artery has been detected in only 40% of the cases. The hepatic veins presented normal caliper and spectral pattern. The duplex proved to be an useful technic complementary and non-invasive, in the study of HSSM.

Ultrasound (US) was performed in 103 patients with hepatosplenic schistosomiasis mansoni. The abnormal US findings are reported and correlated with the pathologic and anatomic characteristics. The main US findings are periportal fibrosis, left lobe hypertrophy, thickening of the wall of the gallbladder, granulomas, splenic nodules, and widening of the portal vessel system. Frequent but nonspecific findings include splenomegaly and the presence of collateral vessels. Portal vein thrombosis was present in a few cases. It is concluded that US is a major tool in the diagnosis of this disease.