Korean J Radiol.  2010 Aug;11(4):485-489. 10.3348/kjr.2010.11.4.485.

Pulmonary Artery Embolotherapy in a Patient with Type I Hepatopulmonary Syndrome after Liver Transplantation

• Lee HW
• Suh KS
• Kim J
• Shin WY
• Yi NJ
• Jae HJ
• Chung JW
• Oh SW
• Kang KW
• Lee KU

• KMID: 984905
• DOI: http://doi.org/10.3348/kjr.2010.11.4.485

Abstract

Although liver transplantation (LT) is the only effective treatment option for hepatopulmonary syndrome (HPS), the post-LT morbidity and mortality have been high for patients with severe HPS. We performed post-LT embolotherapy in a 10-year-old boy who had severe type I HPS preoperatively, but he failed to recover early from his hypoxemic symptoms after an LT. Multiple embolizations were then successfully performed on the major branches that formed the abnormal vascular structures. After the embolotherapy, the patient had symptomatic improvement and he was discharged without complications.

Keyword

Hepatopulmonary syndrome; Pulmonary vasodilatation; Intrapulmonary arteriovenous shunt; Embolization; Liver transplantation

MeSH Terms

Child
Combined Modality Therapy
Echocardiography
Embolization, Therapeutic/*methods
Hepatopulmonary Syndrome/diagnosis/*therapy
Humans
*Liver Transplantation
Male
Oximetry
Positron-Emission Tomography
*Pulmonary Artery
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Embolotherapy for hepatopulmonary syndrome in 10-year-old boy. A. 99m-Tc macroaggregated albumin lung perfusion scanning. Large proportion of radioactive substance was detected in extra-pulmonary areas; mainly brain and kidneys. Amount of intrapulmonary shunting was 45% with assuming that 13% of cardiac output is delivered to brain. B. Pre-transplant pulmonary CT angiography shows diffuse peripheral pulmonary vasodilatation. C. Pre-embolization angiography shows abnormal tortuous and dilated vascular structures in left upper lung field. D. We performed embolization with 8 coils by selecting major branches that formed abnormal vascular structures. Right after embolization, we noted marked decrease in size of abnormal vascular structures and SaO2 had increased by 10%. E. Pre-embolization angiography shows abnormal dilated vascular structures were mainly located in right lower lung field. F. We performed embolization with 9 coils. Patient was discharged three days after second embolization with O2 supplementation of 5 L/min.

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