Chagas disease, also referred as trypanosomiasis, is a tropical parasitic infection with a wide spectrum of clinical manifestations, since it can virtually affect any organ, but there are characteristic radiological features.
Chagas disease is endemic to Central and South America. An estimated 24 million people are infected with 60,000 deaths each year attributed to this infection 8.
Chagas disease is caused by the protozoan Trypanosoma cruzi. It is commonly transmitted to humans by an insect vector.
These are common in endemic regions. The pathogenesis is unclear since the parasite is not often found in heart tissue on autopsy, and an immunologic myocarditis has been suggested as the origin.
Symptoms begin with an acute myocarditis, after which patients enter a latent phase. Approximately 20% of these patients experience gradual fibrous replacement of myofibrils and Purkinje fibers. Eventually, dilated cardiomyopathy ensues, with arrhythmias and heart block. Segmental wall motion abnormalities and apical aneurysm may occur. Heart transplantation has been performed for end stage disease 6.
10-15% of patients are affected with chronic infection, and manifestations include:
- esophageal dysmotility and mega-esophagus
- megaduodenum and small bowel dilatation
- megacolon with left colon and rectosigmoid more commonly affected
Chagas disease is also known to cause dilatation of the ureter.
- chagoma 9
- in immunocompromised patients
Radiographic features of Chagas disease can be seen on barium studies, plain films, CT and MRI.
On cardiac MR, delayed enhancement has been reported in the left ventricular wall in both CAD and non-CAD distributions. The delayed enhancement is progressive over time, and increasing delayed enhancement corresponds with decreasing cardiac performance 7.
- acute chagas cardiomyopathy 10
- chronic chagas cardiomyopathy
- may present with an idiopathic dilated cardiomyopathy phenotype
regional wall motion abnormalities
- basal inferior segment most commonly affected
- left ventricular apical aneurysms
- small subset have right ventricular apical aneurysms
- degree correlates with symptomatology
- asymptomatic patients may have grade I (impaired relaxation) dysfunction
- severely symptomatic patients often demonstrate an irreversible restrictive (grade III) pattern
- degree correlates with symptomatology
History and etymology
Named after Carlos Justiniano Ribeiro Chagas (1879-1934), a Brazilian physician who completely described this infectious disease: the pathogen, the vector, the host, the clinical manifestations and its epidemiology.
- for esophageal disease: achalasia
- 1. Lury KM, Castillo M. Chagas' disease involving the brain and spinal cord: MRI findings. AJR Am J Roentgenol. 2005;185 (2): 550-2. AJR Am J Roentgenol (citation) - Pubmed citation
- 2. Crema E, Cruvinel LA, Werneck AM et-al. [Manometric and radiologic aspects of Chagas' megaesophagus: the importance to its surgical treatment]. Rev. Soc. Bras. Med. Trop. 36 (6): 665-9. - Pubmed citation
- 3. Gomes FR, Secaf M, Kubo TT et-al. Oral and pharyngeal transit of a paste bolus in Chagas' disease. Dysphagia. 2008;23 (1): 82-7. doi:10.1007/s00455-007-9101-8 - Pubmed citation
- 4. Bern C, Montgomery SP, Herwaldt BL et-al. Evaluation and treatment of chagas disease in the United States: a systematic review. JAMA. 2007;298 (18): 2171-81. doi:10.1001/jama.298.18.2171 - Pubmed citation
- 5. Kanne JP, Rohrmann CA, Lichtenstein JE. Eponyms in radiology of the digestive tract: historical perspectives and imaging appearances. Part 2. Liver, biliary system, pancreas, peritoneum, and systemic disease. Radiographics. 2006;26 (2): 465-80. doi:10.1148/rg.262055130 - Pubmed citation
- 6. Fuster V, Walsh R, Harrington R. Hurst's the heart. McGraw-Hill Professional. ISBN:0071636463. Read it at Google Books - Find it at Amazon
- 7. Rochitte CE, Oliveira PF, Andrade JM et-al. Myocardial delayed enhancement by magnetic resonance imaging in patients with Chagas' disease: a marker of disease severity. J. Am. Coll. Cardiol. 2005;46 (8): 1553-8. doi:10.1016/j.jacc.2005.06.067 - Pubmed citation
- 8. Martínez S, Restrepo CS, Carrillo JA et-al. Thoracic manifestations of tropical parasitic infections: a pictorial review. Radiographics. 2005;25 (1): 135-55. doi:10.1148/rg.251045043 - Pubmed citation
- 9. Pittella JE. Central nervous system involvement in Chagas disease: a hundred-year-old history. (2009) Transactions of the Royal Society of Tropical Medicine and Hygiene. 103 (10): 973-8. doi:10.1016/j.trstmh.2009.04.012 - Pubmed
- 10. Acquatella H. Echocardiography in Chagas heart disease. (2007) Circulation. 115 (9): 1124-31. doi:10.1161/CIRCULATIONAHA.106.627323 - Pubmed