case_images: PMC6735636_01
case_images: - MDCT of the thorax - axial images of the lung base (A and B), and the pulmonary apex (C). Note disseminated, bilateral non-calcified micro nodules with centro lobular distribution. The images B and C show wedge-shaped opacities with reversed halo sign, most evident in C compatible with pulmonary infarction.
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case_images: - MDCT of the abdomen, obtained after oral and intravenous contrast media. In A a reformatted coronal image showing an heterogeneous enhancement of the hepatic parenchyma mainly at the periphery of the hepatic right lobe. Note patent portal vein of normal caliber, and lack of hepatosplenomegaly. In B - axial image - note the thickening of the intestinal wall.
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case_images: - MDCT of the abdomen, reformatted image, obtained after oral and intravenous contrast media. Note slightly enlarged mesenteric lymph nodes, thickening of the intestinal wall and presence of mild ascites.
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case_images: - A- Panoramic picture of the abdominal cavity showing distended bowel segments covered by a whitish and thick serosa and mild ascites. B- Detail of small bowel surface serosa showing the whitish granular thickness.
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case_images: The visceral peritoneum showed a whitish diffuse thickening throughout the gastrointestinal tract from the stomach to the colon. (Figure 4).
case_images: - Photomicrography (HE-400x) - A and B- Viable adult S. mansoni worms within vessel lumen.
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case_images: There were also observed numerous viable and dead worms in the lumen of veins, especially in the subserosal layer and occasionally in the submucosa (Figures 5 and 6).
case_images: - Photomicrography - A- (HE-100x) Gastric wall presenting viable S. mansoni adult worms within a venous vessel of the submucosa and presence of numerous eggs in the lamina propria of the mucosal layer; B- (HE-400x) Presence of calcified eggs within the large intestine submucosal layer; C- (HE-200x) Scar fibrotic granuloma surrounding egg debris within the large intestine subserosa; D- (HE-200x) Necrotic-exudative pattern granuloma involving viable eggs within the large intestine subserosal layer.
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case_images: There were also observed numerous viable and dead worms in the lumen of veins, especially in the subserosal layer and occasionally in the submucosa (Figures 5 and 6).
case_images: - A- Gross examination of the liver showing winy hepatic parenchyma presenting multiple whitish micro nodules. Note the fibrous thickness of portal space; B- Detail of the whitish fibrous thickening of the portal space, characterizing the presence of Symmers fibrosis.
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case_images: Multiple whitish granules scattered randomly in the parenchyma were present, more evident in the left lobe (Figure 7).
case_images: - Photomicrography - A (HE-100x) Portal space presenting a necrotic exudative granuloma with eosinophils besides the presence of a calcified egg and Symmers fibrosis; B (HE-100x) Hepatic parenchyma presenting passive congestion with hepatocyte necrosis in zones 2 and 3; C (HE-400x) Presence of a scar granuloma with concentric fibrosis involving a calcified egg within the hepatic parenchyma; D (HE-400x) Presence of necrotic-exudative pattern granuloma surrounding a viable egg within the portal space. Note the presence of blackened schistosome pigment deposition in all these photomicrographies.
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case_images: In the hepatic lobule there were also extensive areas of sinusoidal congestion and hepatocyte necrosis, especially in zones 3 and 2, with areas of microvesicular steatosis (Figure 8).
case_images: - A- Gross examination of the pancreas showing whitish thickening of the anterior surface, preserved parenchyma lobulation on sectioning and lack of steatonecrosis; B- Gross examination of the spleen showing a homogeneous winy parenchyma on sectioning surface.
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case_images: On microscopy, it was observed countless embryonated eggs entrapped in the pancreatic parenchyma, some of them surrounded by granulomatous reaction exhibiting a necrotic-exudative pattern with eosinophil (Figures 9 and 10). The microscopy showed white pulp reactive hyperplasia and red pulp congestion with no evidence of congestive spleen sclerosis (Figures 9 and 10).
case_images: - Photomicrography (HE-200x) - A- Numerous viable eggs of S. mansoni within the pancreatic parenchyma; B- Splenic parenchyma showing white pulp reactive lymphoid hyperplasia.
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case_images: On microscopy, it was observed countless embryonated eggs entrapped in the pancreatic parenchyma, some of them surrounded by granulomatous reaction exhibiting a necrotic-exudative pattern with eosinophil (Figures 9 and 10). The microscopy showed white pulp reactive hyperplasia and red pulp congestion with no evidence of congestive spleen sclerosis (Figures 9 and 10).
case_images: - A- Panoramic picture of the left lung showing a cavitary lesion in the apex of the superior lobe; B- Panoramic picture of right lung sectioning surface showing multiple whitish nodules and the presence of a triangular whitish area corresponding a inferior lobe infarction; C- Detail of the right inferior pulmonary lobe showing multiples tiny whitish nodules, measuring up to 0,1 cm and a triangular infarction area; D- Sectioning surface of the left superior pulmonary lobe showing an apical cavitary lesion.
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case_images: In the base of the right lung, a grayish triangular area of firm consistency was detected resembling a pulmonary infarction (Figure 11).
case_images: - Photomicrography - A (HE - 100X) Peribronchial arterial vessel showing endarteritis and granulomatous reaction surrounding viable eggs of S. mansoni; B (HE - 400X) Presence of dead worms, with coagulative necrosis, within the lumen of a small bronchus; C (HE - 100X) Lung parenchyma exhibiting the presence of necrotic-exudative granulomas surrounding viable eggs and alveolar edema; D (HE - 400X) Lung parenchyma exhibiting the presence of exudative granuloma with intense infiltration of eosinophils.
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case_images: On the wall of the left upper lobe cavity lesion it was identified the presence of countless embryonated eggs (Figure 12).