Fig. 11

Intestinal schistosomiasis. a. US-Doppler axial image from a Filipino patient with chronic infection by S. japonicum. Note also the stigmata of chronic liver disease (caudate and left lobes hypertrophy, heterogeneous parenchyma and irregular surface). Periportal fibrosis appears as echogenic cuffing around portal vessels (arrows), note left portal vein (asterisk). Characteristic fibrotic septa are seen perpendicular to the surface (arrowheads). b. Unenhanced CT image with iodinated oral contrast from the same patient as in figure a. It shows fibrosis with calcified septa (“turtle back” appearance) in the right liver lobe (arrows). Note also the imaging findings consistent with chronic liver disease (atrophy of the right liver lobe with hypertrophy of the left and caudate lobes). c. A month later the patient from figures a and b came to the ER with acute abdominal pain; unenhanced CT with iodinated oral contrast was performed, showing a perforated duodenal ulcer with oral contrast leakage (arrowhead), microbiological and pathological exams probed that it was a duodenal ulcer caused by S. japonicum. d. Gadolinium-enhanced axial T1-weighted MR image with fat suppression of a patient from Guinea-Conakry with chronic S. mansoni infection, it shows almost complete atrophy of the left portal vein and periportal fibrosis, seen as a hypointense periportal cuffing (arrow)