Background Hepatosplenic schistosomiasis (HES) has not been evaluated by transient elastography so far and its correlation with ultrasound variables remains to be defined. Aims The aim of this study was to describe the parameters of liver and spleen stiffness in HES assessed by transient elastography in comparison with cirrhotics and controls evaluating its correlation with ultrasonographic data. Patients and methods HES, hepatitis C virus-cirrhotic, and control patients were included in this sectional study. Liver and spleen stiffness were compared among the three groups. The ultrasonographic parameters were compared with transient elastography in HES patients. Results Thirty HES, 30 hepatitis C virus-cirrhotic patients, and 17 controls were included. Those with HES presented liver stiffness that was significantly higher than the controls and lower than the cirrhotics: 9.7 (3.6-75.0) versus 3.7 (2.8-5.4) versus 27.0 (14.7-61.5) kPa (P < 0.001). Spleen stiffness values were comparable between hepatosplenic and cirrhotics: 66.4 (25.7-75.0) versus 69.1 (18.0-75.0) kPa (P = 0.78) and were significantly higher than the controls 16.5 kPa (6.3-34.3) (P < 0.001). In patients with HES, high spleen stiffness was associated with right liver lobe diameter (P = 0.015), splenic artery resistance index (P = 0.002), portal vein diameter (P = 0.021), portal vein area (P = 0.008), portal vein congestion index (P = 0.035), splenic vein diameter (P = 0.013), and spleen diameter (P = 0.021). Conclusion Liver stiffness may be a useful tool to differentiate portal hypertension related to cirrhosis from that of HES. High spleen stiffness is a potential surrogate marker of portal hypertension in this population. Copyright (C) 2017 Wolters Kluwer Health, Inc. All rights reserved.