Dilated paraumbilical vein in hepatosplenic schistosomiasis associated with pulmonary hypertension

Abstract

Revista da Sociedade Brasileira de Medicina Tropical 46(6):797, Nov-Dec, 2013http://dx.doi. org/10.1590/0037-8682-0193-2013 Dilated paraumbilical vein in hepatosplenic schistosomiasis associated with pulmonary hypertension A 58-year-old female patient was admitted to hospital with a history of dyspneia, cough and chest pain which started one year before the present admission. In the last 15 days she noticed worsening of her previous symptoms. There was also peripheral edema, tachycardia and palpitation with limitation corresponding to functional class IV (World Health Organization). She came from an area endemic for schistosomiasis and had the hepatosplenic form of the disease. She was also obese. Abominal ultrasound confirmed the diagnosis of periportal fi brosis and portal hypertension. Chest X-ray showed a prominent fourth arch (Figure A: white arrow). Right heart catheterization showed a pulmonary artery systolic pressure of 88mmHg and a mean pulmonary pressure of 46mmHg. A computerized tomography of the abdomen with 3D reconstruction showed the presence of a large venous shunt (dilated paraumbilical vein) connecting the portal system to the left iliac vein/inferior vena cava (Figure B). Magnetic resonance A B CREFERENCES imaging of the heart revealed a great dilation of the pulmonary artery (Figure C: short arrow: pulmonary truncus; large arrow: left pulmonary artery; RV: right ventricle). In this case the contribution of the porta-pulmonary shunt to the development of pulmonary hypertension has been suggested as one of the many factors responsible for this complication in hepatosplenic schistosomiasis mansoni.

Pulmonary Vascular Diseases Secondary to Schistosomiasis

“…The portal hypertension-induced venous shunts between the portal and systemic circulation facilitate the passage of Schistosoma eggs from the liver to the lungs. [15][16][17][18] Crosby et al 19 noticed that levels of bone morphogenetic protein receptor II (BMPR2) modify the pulmonary vascular response to chronic schistosomiasis. BMPR2+/-mice demonstrated dilatation of the hepatic central vein at baseline and post infection, compared with wild type, suggesting increased passage of eggs to the lungs.…”

Doxycycline hyclate stimulates inducible nitric oxide synthase and arginase imbalance, potentiating inflammatory and oxidative lung damage in schistosomiasis

“…Then, S. mansoni reaches the liver and mesenteric portal vessels, where they evolve into adult forms and start oviposition. Finally, the parasite eggs spread through the bloodstream and are trapped in multiple tissues and organs, triggering a systemic inflammation [ 6 , 7 ]. From venous portocaval shunts, S. mansoni eggs reach the lung parenchyma [ 7 ], and its soluble antigens trigger a marked granulomatous inflammation [ 2 ].…”

“…Finally, the parasite eggs spread through the bloodstream and are trapped in multiple tissues and organs, triggering a systemic inflammation [ 6 , 7 ]. From venous portocaval shunts, S. mansoni eggs reach the lung parenchyma [ 7 ], and its soluble antigens trigger a marked granulomatous inflammation [ 2 ]. This process is dependent on a well-polarized Th2 phenotype, which orchestrates granuloma organization in a protective mechanism to isolate S. mansoni eggs, restrict continuous antigenic stimulation and immunomediated tissue damage [ 8 ].…”