IMAGING DIAGNOSIS—HETEROBILHARZIA AMERICANA INFECTION IN A DOG

Abstract

An approximately three-year-old mixed breed female dog was evaluated for peritoneal effusion, anorexia, intermittent vomiting, and diarrhea. Radiographically, there was mineralization of the wall of small intestinal segments. Sonographic findings were consistent with multisystemic mineralization of liver, small intestinal wall, and pancreas. Multifocal granulomas containing schistosome eggs (Heterobilharzia americana) were identified histologically. The mineralization pattern described herein is an uncommon presentation of severe diffuse heterobilharziasis in a dog.

Pancreas

“…53 Granulomas containing schistosome eggs were identified histologically. 53 Granulomas containing schistosome eggs were identified histologically.…”

Gastrointestinal Tract

“…The appearance is due to the multiple wall layers making up the intussusception. 92,93 Thickening of the muscularis layer in the small bowel, equal to or thicker than the mucosal layer, has been frequently reported in cats. A variable amount of bowel dilation is seen proximal to the intussusception, depending on whether a partial or complete bowel obstruction is present.…”

Sonographic findings of pinpoint hyperechoic foci in the small intestine, liver, and mesenteric lymph nodes are indicative of canine Heterobilharzia americana infection

“…A wide variety of clinicopathological abnormalities has been described in association with this disease: hyper-or hypocalcemia, hyper-or hyposphosphatemia, hypernatremia, hyper-or hypocholesterolemia, hyperglobulinemia, hypoalbuminemia, azotemia, anemia, eosinophilia or eosinopenia, and thrombocytopenia. 5,[8][9][10][11][12][13][14] The inconsistency of the clinical signs and clinicopathologic findings complicates the identification of patients requiring definitive testing for schistosomiasis.…”

“…In several publications, thin linear mineral opacities were noted radiographically in the abdominal cavity or superimposed over the small intestines, and may correspond to the walls of the small intestine. 12,14 Findings on abdomi-nal ultrasonography are variable, and may indicate mineralization of affected organs. Affected hepatic parenchyma has been reported as hyperechoic and heterogeneous/mottled or containing hyperechoic pinpoint foci.…”

“…6,8,12,14 Another common finding is a thickened and irregular small intestinal tunica submucosa, which has been described as diffusely hyperechoic, or containing pinpoint or linear hyperechoic foci. 6,8,11,12,14 Similar changes may be appreciated in the small intestinal muscularis layer. 8 Other reported findings include hyperechoic foci within the pancreas, enlarged abdominal lymph nodes, and peritoneal effusion.…”