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Grades of Homeida et al for Symmers' Periportal Fibrosis in Schistosoma mansoni Infection

Description

Patients with Schistosoma mansoni infections may develop Symmers' periportal fibrosis. This may progress to portal hypertension with development of collateral circulation and esophageal varices. Homeida et al developed a grading scheme for the periportal fibrosis which can be used for ultrasonography.


 

Ultrasonographic evidence of periportal fibrosis:

(1) presence of echogenic thickening of the main portal vein

(2) variable degrees of echogenic thickening of the walls of the portal vein radicles

(2a) longitudinal bands of irregular thickness when the veins are scanned longitudinally

(2b) round echogenic foci with central lucency when scanned across their long axis

(3) diffuse homogeneous echogenic thickening of the gallbladder walls

 

Grade

Findings

I

minimal echogenic thickening in the walls of >= 2 portal vein radicles;

little or no change in the diameter of the main portal vein;

no thickening of the gallbladder wall

II

mild echogenic thickening in the walls of >= 2 portal vein radicles, mainly those peripherally located;

little or no change in the diameter of the main portal vein;

gallbladder wall thickened

III

moderate to severe periportal thickening in the walls of most portal vein radicles with marked narrowing of the central lucency;

walls of the veins are irregular in thickness, especially at bifurcations

thickened bands extend to the surface of the liver

the wall of the main portal vein is thickened from 2-10 mm

gallbladder wall thickened

IV

marked thickening of the walls of the portal vein radicles with obliteration of the central lucency in the peripheral branches, with extensive thick echogenic bands reaching the periphery of the liver

the wall of the main portal vein is thickened from 10-20 mm

liver is small and shrunken with irregular surface

gallbladder wall greatly thickened

 


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Specialty

ICD-10