IMAGES IN INFECTIOUS DISEASES
Pulmonary hypertension in schistosomiasis mansoni
José Roberto Lambertucci; Vinicius Tostes Carvalho; Luciana Cristina dos Santos Silva
Serviço de Doenças Infecciosas e Parasitárias da Faculdade de Medicina da Universidade Federal de Minas Gerais, Belo Horizonte, MG, Brasil
Address to Address to: Prof. José Roberto Lambertucci Deptº de Clínica Médica/FM/UFMG Av. Alfredo Balena 190 30130-100 Belo Horizonte, MG, Brasil e-mail: lamber@uai.com.br
A 31-year-old woman was admitted to hospital reporting shortness of breath for 10 days. She also reported chest pain and 3 episodes of exertional syncope in the 8 months prior to examination. She had been admitted to an intensive care unit (ICU) 6 months before the present admission, with a presumptive diagnosis of pulmonary thromboembolism. Physical examination revealed increased intensity of the pulmonic component of the second heart sound, with a spleen palpable 3cm below the left costal margin. Chest radiograph showed enlargement of the central pulmonary arteries (Figure A). Electrocardiogram showed right axis deviation, R/S ratio > 1 in lead V1, and increased P wave amplitude in lead II. Two-dimensional transthoracic echocardiography with Doppler analysis revealed a systolic pulmonary pressure of 101mmHg. Right-sided cardiac catheterization showed a mean pulmonary pressure of 88 mmHg and a systolic pressure of 140mmHg. Helical CT scans were performed after intravenous contrast injection (Figure B A = aorta; P = dilated pulmonary trunk). Three-dimensional reconstruction using helical CT is shown in Figure C (note the aneurismal dilation of the pulmonary artery larger white arrow - and, in the insert, the enlargement of the right pulmonary artery). The patient has had a diagnosis of hepatosplenic schistosomiasis mansoni confirmed by ultrasound, with esophageal varices documented by upper endoscopy.
REFERENCES
1. Barbosa MM, Lamounier JA, Oliveira EC, Souza MV, Marques DS, Silva AA, Lambertucci JR. Pulmonary hypertension in schistosomiasis mansoni. Transactions of the Royal Society of Tropical Medicine and Hygiene 90:663-665, 1996.
2. Lambertucci JR, Moreira RF, Barbosa AJ. Solitary pulmonary nodule caused by Schistosoma mansoni in a patient with medullary thyroid carcinoma. Revista da Sociedade Brasileira de Medicina Tropical 38:536-537, 2005.
3. Lambertucci JR, Serufo JC, Gerspacher-Lara R, Rayes AA, Teixeira R, Nobre V, Antunes CM. Schistosoma mansoni: assessment of morbidity before and after control. Acta Tropica 77:101-109, 2000.
Recebido para publicação em 7/4/2006
Aceito em 13/4/2006
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Publication Dates
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Publication in this collection
31 July 2006 -
Date of issue
June 2006