Grading of hepatic schistosomiasis by the use of ultrasonography.

Forty-three subjects with pure hepatic schistosomiasis having ultrasonographic assessment of periportal fibrosis were grouped according to the thickness of their portal tracts: grade I = 3-5 mm, grade II = greater than 5-7 mm, and grade III = greater than 7 mm. A history of hematemesis, blood transfusion, sclerotherapy, and lower limb edema correlated with the ultrasonographic grade of periportal fibrosis. With increasing grade, the average liver size was smaller and the average spleen size was larger, as determined by physical examination and by ultrasonography. Abnormalities in serum enzyme levels were more frequent in those with thicker portal tracts. Greater diameters of the portal and splenic veins and ultrasonographically detectable collateral blood vessels were associated with increasing thickness of portal tracts. The grade of endoscopically determined esophageal varices was highly correlated with the grade of periportal fibrosis. We concluded that this method of grading accurately reflects the hemodynamic changes and provides a good estimate of the clinical status of patients who have periportal fibrosis due to schistosomiasis mansoni. Where available, it should replace clinical grading based upon the liver and spleen size as detected by physical examination.