The imaging diagnosis of hepatic schistosomiasis japonicum sequelae

We reviewed the ultrasound (US) and computed tomography (CT) examinations of the liver in 21 patients with hepatic schistosomiasis japonicum (HSJ), to assess the role of imaging in its diagnosis. Thirteen patients had histopathological evidence of hepatic ova deposition. A 'network' pattern was present in 14 of 17 (82%) patients on US, and 'turtle-back' calcification in 11 of 13 (85%) patients on non-contrast CT (NCCT). The combination of US and NCCT was positive for HSJ in all nine patients subjected to both investigations. These findings are specific for HSJ and we discuss how they differ from the imaging findings reported in hepatic Schistosoma mansoni (HSM). We conclude that the sequelae of HSJ infection create an imaging diagnosis. Although an uncommon incidental finding at liver imaging, the combined US and CT appearances are so characteristic that in the majority of patients biopsy can potentially be avoided.