title: Pulmonary shunts in severe hepatosplenic schistosomiasis: Diagnosis by contrast echocardiography and their relationship with abdominal ultrasound findings.
abstract: BACKGROUND
  Schistosomiasis is endemic to several parts of the world. Among the species that affect humans, Schistosoma mansoni is one of the most common causes of illness. In regions where schistosomiasis mansoni is endemic, reinfection is responsible for the emergence of hepatosplenic schistosomiasis (HSS) with portal hypertension in about 10% of infected individuals. Regardless of its etiology, portal hypertension may bring about the formation of arteriovenous fistulas and pulmonary vascular dilation, thus constituting a pulmonary shunt and its presence has been associated with the occurrence of neurological complications. The objective of this study was to identify pulmonary shunt using TTCE in patients with HSS and esophageal varices, and to compare the abdominal ultrasound and endoscopy findings among patients with and without pulmonary shunt.
  
  
  RESULTS
  In this case series, a total of 461 patients with schistosomiasis mansoni were prospectively evaluated using abdominal ultrasound and endoscopy and 71 presented with HSS with esophageal varices. Fifty seven patients remained in the final analysis. The mean age of the patients was 55 ± 14 years, and 65% were female. Pulmonary shunts were observed in 19 (33.3%) patients. On comparing the groups with and without pulmonary shunt, no significant differences were observed in relation to the abdominal ultrasound and endoscopic findings. When comparing the two subgroups with pulmonary shunts (grade 1 vs grades 2 and 3), it was observed that the subgroup with shunt grades 2 and 3 presented with a significantly higher frequency of an enlarged splenic vein diameter (>0.9 cm), and an advanced pattern of periportal hepatic fibrosis (P = 0.041 and P = 0.005, respectively). None of the patients with pulmonary shunts had severe neurological complications.
  
  
  CONCLUSIONS
  Our findings suggest that in HSS with esophageal varices the pulmonary shunts may be present in higher grades and that in this condition it was associated with ultrasound findings compatible with advanced HSS.
authors.affiliation: Graduate Program in Tropical Medicine, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Liana
authors.identifier: http://orcid.org/0000-0002-0481-5130
authors.initials: L
authors.lastname: Gonçalves-Macedo
authors.affiliation: Department of Clinical Medicine, Universidade Federal de Pernambuco, Recife, Brazil.|Center for Gastroenterology and Hepatology, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Ana Lucia Coutinho
authors.initials: AL
authors.lastname: Domingues
authors.affiliation: Department of Clinical Medicine, Universidade Federal de Pernambuco, Recife, Brazil.|Center for Gastroenterology and Hepatology, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Edmundo Pessoa
authors.initials: EP
authors.lastname: Lopes
authors.affiliation: Laboratory of Quantitative Health Methods, Fundação Oswaldo Cruz (Fiocruz), Recife, Brazil.
authors.forename: Carlos Feitosa
authors.initials: CF
authors.lastname: Luna
authors.affiliation: Department of Clinical Medicine, Universidade Federal de Pernambuco, Recife, Brazil.|Center for Cardiology and Echocardiography, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Vitor Gomes
authors.initials: VG
authors.lastname: Mota
authors.affiliation: Department of Clinical Medicine, Universidade Federal de Pernambuco, Recife, Brazil.|Center for Cardiology and Echocardiography, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Mônica Moraes de Chaves
authors.initials: MM
authors.lastname: Becker
authors.affiliation: Department of Clinical Medicine, Universidade Federal de Pernambuco, Recife, Brazil.|Center for Cardiology and Echocardiography, Universidade Federal de Pernambuco, Recife, Brazil.
authors.forename: Brivaldo
authors.initials: B
authors.lastname: Markman-Filho
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000328:Adult; D000368:Aged; D000818:Animals; D004452:Echocardiography / Q000379:methods; D004932:Esophageal and Gastric Varices / Q000150:complications / Q000000981:diagnostic imaging* / Q000469:parasitology / Q000503:physiopathology; D005260:Female; D006801:Humans; D006975:Hypertension, Portal / Q000150:complications / Q000000981:diagnostic imaging* / Q000469:parasitology / Q000503:physiopathology; D008109:Liver Diseases, Parasitic / Q000150:complications / Q000000981:diagnostic imaging* / Q000469:parasitology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012550:Schistosoma mansoni / Q000302:isolation & purification*; D012555:Schistosomiasis mansoni / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D013158:Splenic Diseases / Q000150:complications / Q000000981:diagnostic imaging* / Q000469:parasitology / Q000503:physiopathology; D014463:Ultrasonography