Frequency and Clinical Significance of Intrapulmonary Shunt in Liver Cirrhosis; Detection by Contrast Echocardiography

Jeong, Seok; Bae, Sung Kwon; Kwon, Kye Sook; Cho, Seong Wook; Koh, Kwang Kon; Shin, Yong Woon; Cho, Sang Kyoon; Kim, Soon Hye; Kim, Sam Soo

Abstract

OBJECTIVES
Intrapulmonary vascular abnormalities resulting in right-to-left shunt have been described in patients with severe liver disease, especially advanced hepatic cirrhosis. They result in hypoxemia which is associated with liver cirrhosis without preexisting cardiac or pulmonary diseases. Since Rydell and Hoffbauer first described intrapulmonary shunt in a cirrhotic patient in 1956, it has been reported recently that 13 to 47 percent of the end-stage hepatic disease patients have these intrapulmonary vascular abnormalities. Contrast echocardiography(CE) has been proved useful in detecting intrapulmonary shunt. The aim of the study is to determine the prevalence of intrapulmonary shunt by CE in patients with hepatic cirrhosis, and to compare the clinical characteristics of those with and without evidence of intrapulmonary shunt.
METHODS
We performed CE studies in 24 stable cirrhotic patients without the evidence of severe complications such as massive ascites, upper GI bleeding, and hepatic coma. Clinical information including symptom and sign, results of liver and pulmonary function tests, and arterial blood gas values measured both at the supine and erect position, were analyzed in each group of patients with or without intrapulmonary shunt.
RESULTS
Positive CE suggesting intrapulmonary shunt was found in 8 of 24 patients(33.3%). However the degree of relative opacifications were one positive(1+) in all 8 patients, and hypoxemia and its related symptom and sign appeared to be rare. Any of the parameters of liver and pulmonary function test did not show the significant difference between CE-positive and CE-negative group.
CONCLUSION
Only the presence of spider angioma was associated with intrapulmonary shunt among the several clinical signs, which suggests common pathogenesis of both vascular abnormalities.