PMC4891583_01
Abdominal ultrasound demonstrates a small liver with heterogeneously coarse echotexture. Multiple round echogenic areas with central lucency are seen in this sagittal image of the left hepatic lobe (arrows), consistent with "bull's eye" appearance of fibrosis surrounding portal venous structures. B. Close-up view of a round echogenic focus seen in the right hepatic lobe. Central lucency represents portal venous structure. [Powerpoint Slide]
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In a sagittal plane, there were multiple round echogenic areas present in both the right and left hepatic lobes (Figure 1).
CT from two years prior demonstrating fatty liver and periportal fibrosis. These images are similar in appearance to those of previous case reports demonstrating CT appearance of schistosomiasis. A, B. Arterial phase images show hypoattenuated round and linear branching lesions traveling adjacent to enhancing hepatic arterial branches (arrows).C, D. These lesions enhance during portal phase (arrows). E, F. The gallbladder wall is nodular and thickened and measures 4 mm. [Powerpoint Slide]
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CT imaging from two years prior had demonstrated periportal enhancement consistent with periportal fibrosis (Figure 2).
MDCT for evaluation of abnormal LFTs, illustrating irregular liver surface and periportal fibrosis as seen in schistosomiasis. Arterial phase demonstrates hepatic arterial branches as enhancing structures with surrounding hypodensities (arrows). Hypodense areas represent both periportal fibrosis and the portal venous system prior to contrast enhancement. [Powerpoint Slide]
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In the arterial phase, the hepatic arterial branches were seen as enhancing branching structures traveling adjacent to hypodense areas (Figures 3A and B). During the portal phase, the portal venous branches enhanced strongly, and were surrounded by two concentric rings of hypoattenuation and enhancement (Figures 3C and D).
MDCT for evaluation of abnormal LFTs, illustrating irregular liver surface and periportal fibrosis as seen in schistosomiasis. Portal phase demonstrates enhancement of portal venous structures surrounded by inner ring of hypoattenuation and outer ring of enhancement (arrows). Hypoattenuated ring presumably represents areas of periportal fibrosis with decreased vascularity, whereas enhancing rim may be due to periportal inflammation. These concentric rings correspond to the "bull's eye" appearance of periportal fibrosis previously described with ultrasound. [Powerpoint Slide]
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Stranding was seen around the gallbladder; there was no evidence of stones or biliary dilatation (Figure 4).