THE UTILITY OF CT OF THE CHEST IN DETECTION OF VASCULAR CHANGES IN BILHARZIAL COR-PULMONALE

Abstract

Thoracic computed tomograhpy (CT) has become an integral part of the daily practice of radiology. It plays an important role in differentiating pulmonary vascular disease from other hilar pathology. However, the use of (CT) for diagnosing lung disease was limited to the detection of lung nodules and differentiating lung disease from pleural disease. Now, high-resolution spiral (helical) CT has become widely available. It can demonestrate both the normal and abnonnal lung interstitiwn and morphological characteristics of localized and diffuse parenchymal abnormalities. The present work aimetl to studyiiil:g the conventional and spiral (helical) computed tomography in the radiological evaluation of bilharzia! cor­ pulmmonale. This study included twenty-two patients infected with intestinal bilharziasis, and grade III hepato-splenic affection. These patients were classified clinically according to the manifestations of pulmonary hypertension into 2 groups 1&2, eleven patient in each group. Patients of group 1 were those of bilharzia! cor-puhnonale with age ranging from 32-65 years and a mean of 51.73 years± 9.77SD, and those of group 2, patients without bil11arzial cor­ pulonale with age ranging from 35-76 years and a mean of52.77± 10.38 SD. Every patient was subjected to: a thorough history taking, complete physical examination, laboratory investigations (stool analysis, complete blood picture, bilharzia! antibody titer, blood urea, serwn creatinine, SGPT, SGOT, alkaline phosphatase, plasma protien, plasma albumin, total and direct biliruben, LE cells, rhewnatoid factor, ANA, fasting and 2 hours post prandial blood glucose levels), abdominal ultrasound, upper GIT endoscopy, ECG, plain X-ray chest, echocardiography, computed tomography of the chest both conventional and spiral (helical) with IV contrast, and ventilatory pulmonary function tests. Cardiomegaly, right ventricular apex and dilatation of the pulmonary artery were detected by palin X-ray chest in all cases of group 1 and 2 cases of group 2. The diameter of the right descending puhnonary artery in group 1 ranged from 8-16mm with a mean ofll.73mm±7.63SD,withasignificant difference between group I and 2 (P-value <0.01). There were direct significant correlations between the diameter of the right descending pulmonary artery by plain chest X-ray and the RVEDD, MPAP and SPAP measured by 2D-echocardiography. The diameters of the main, right and left pulmonary arteries were