Various pathological changes associating schistosomal cor-pulmonale are still unclear. The role of CT in diagnosis such abnormalities has not been fully evaluated. Aiming to study the efficacy of CT in diagnosis of schistosomal cor-pulmonale, twenty two patients with pure hepatic Schistosoma mansoni infection were selected. Patients were selected according to the physical, ECG and OCR parameters into: group I (nr-1 I) with diagnostic .manifestations of corpulmonale and group II (n=11) without these manifestations. All patients were subjected to history taking, thorough clinical examination, chest radiographs, ECG and laboratory investigations (CBC, ESR, liver function tests, HBs Ag, HCV Ab, circulating schistosomal antigen , rheumatoid factor, LE cells and ANA). Cases with heart, chest or hepatic diseases other than schistosomiasis were excluded. For all patients, upper GIT endoscopy, abdominal ultrasonography, EchoDoppler and post contrast spiral CT chest were performed. Serum alanine transaminase was significantly higher and prothrombin concentration was significantly lower in corpulmonale cases comparing those without (p< 0.05). Abdominal ultrasonography detected portal vein thrombosis in one (9.9%) and ascites in 4 cases in group I (36.36%) but none in group II . Endoscopic evidence of oesophageal varices was found in 3 of corpulmonale cases (27.27%) versus none in group II. Aneurysmal dilatation of pulmonary artery was present in 7 out of the 11 schistosomal cor-pulmonale cases (63.63%). Echocardiographic studies revealed a high significant difference on measuring right ventricular end diastolic diameter (51 ± 16.6 vs. 28.5 ± 14.38, p <0.5), main pulmonary artery diameter (57.72 ± 28.82 vs. 12.09 ± 1.97, p< 0.05), right pulmonary artery diameter (32 ± 8.01 vs. 9 ± 2.15 p< 0.1), acceleration time (30 ± 3.54 vs. 110 ± 46.44,p <0.5) and main pulmonary artery pressure (105.8 ± 28.71 vs. 28.8 ± 23.65,p< 0.5) between group I and group II in sequence. Spiral CT results in diagnosis of schistosomal corpulmonale were parallel to other radiological studies, but CT had its superiority in detecting multiple pulmonary arteries thrombi in 4 cor-pulmonale cases. Among our cases of schistosomal cor-pulmonal , thrombus formation was related to previous splenectomy , pulmonary aneurysm, oesophageal varices , and portal vein thrombosis. This study emphasises the role of post contrast CT in diagnosis of pulmonary artery thrombosis in bilhazial corpulmonale especially in post splenectomy patients and those wi |
