Tuberc Respir Dis.  2009 Jan;66(1):47-51.

A Case of Hepatopulmonary Syndrome in a Patient with Child-Pugh Class A Liver Cirrhosis

• Kim JS
• Kim C
• Kim GS
• Lim DS
• Hwang HK
• Ro YM

Abstract

Hepatopulmonary syndrome (HPS) is characterized by a defect in arterial oxygenation that's induced by pulmonary vascular dilatation in the setting of liver disease. Some studies have shown the relationship between the presence of the HPS and the severity of liver disease, but there are only rare cases of HPS inpatient with Child-Pugh class A liver cirrhosis. We report here on a case of a 58 years-old male who suffered from progressive dyspnea for the previous few years. He was diagnosed with alcoholic liver cirrhosis 5 years previously. There was no significant abnormality on the chest radiograph and transthoracic echocardiography, but the arterial blood gas analysis revealed severe hypoxemia. Contrast-enhanced transesophageal echocardiograpy with agitated saline demonstrated a delayed appearance of microbubbles in the left cardiac chambers. Thus, he was finally diagnosed with HPS. This case suggests that we should consider HPS when a patient with compensated liver cirrhosis has unexplained dyspnea.

Keyword

Hepatopulmonary syndrome; Hypoxemia; Liver cirrhosis; Liver transplantation

MeSH Terms

Anoxia
Blood Gas Analysis
Dihydroergotamine
Dilatation
Dyspnea
Echocardiography
Hepatopulmonary Syndrome
Humans
Inpatients
Liver
Liver Cirrhosis
Liver Cirrhosis, Alcoholic
Liver Diseases
Liver Transplantation
Male
Microbubbles
Oxygen
Thorax
Dihydroergotamine
Oxygen

Figure

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  Figure 1 A chest CT image showed multiple nodular and branching structures in the secondary pulmonary lobules around subpleural portion (arrow).

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  Figure 2 (A) The contrast-enhanced transesophageal echocardiograms with agitated saline showed microbubbles opacifying only the right cardiac chambers. (B) After 3 heart beats, microbubbles opacified the left cardiac chambers, suggesting intrapulmonary shunt.

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  Figure 3 The technetium-99m-labeled magroaggregated albumin perfusion scan revealed abnormal uptakes in the brain, thyroid gland, and kidneys, indicating right-to-left shunt. The ratio of lung to whole body uptakes was 0.74, and brain uptake rate was 7.62%.

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