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Hepatopulmonary Syndrome and Intrapulmonary Shunts in Patients with Hepatosplenic Schistosomiasis

Description

A patient infected with Schistosoma mansoni may develop hepatosplenic schistosomiasis. As hepatic fibrosis progresses the patient may show evidence of portal hypertension with splenomegaly and esophageal varices. A patient with advanced disease may also develop intrapulmonary shunting and the hepatopulmonary syndrome.


Features of hepatosplenic schistosomiasis with portal hypertension:

(1) splenomegaly (longitudinal diameter >= 13 cm)

(2) esophageal varices

(3) evidence of significant periportal fibrosis

 

Clinical findings associated with intrapulmonary shunting:

(1) hypoxemia and cyanosis

(2) paradoxical cerebral embolization

 

The diagnosis of intrapulmonary shunting can be established by transthoracic contrast echocardiography (TTCE). An intrapulmonary shunt is present if microbubbles (contrast) injected into the peripheral vein are seen in the left atrium between the fourth and sixth cardiac cycle.


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