Various pathological changes associating schistosomal tor-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 CXR parameters into: group I (n=11) 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, 1113s 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, Echo- Doppler and post contrast spiral CT chest were performed. Serum alanine ransaminase 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 of cor- .pulmonale 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 corp ulmonaleespecially in post splenectomy patients and those with pulmonary artery aneurysm, oesophageal varices and for portal vein thrombosis. |
