Discussion
Diagnosis With Brief Discussion
- Diagnosis
- Hepatopulmonary syndrome
- Radiologic Findings
- Fig 1. Chest PA shows basilar reticulonodular opacities, suggesting dilated peripheral vascular markings in both lung fields.
Fig 2-4. CT scans reveals prominent dilatation of pulmonary arteries and veins in subpleural area of both lungs.
Fig 5. CT scan at the level of upper abdomen shows lobulated bulging contour of liver with mild splenomegaly, suggesting liver cirrhosis
- Brief Review
- The diagnosis of hepatopulmonary syndrome is established with the following three criteria: chronic liver disease, increased alveolar-arterial gradient on room air, and evidence of intrapulmonary vascular dilatation. Hypoxemia is seen in one-third of decompensated cirrhotic patients. The most important mechanism is pulmonary vascular dilatation and consequent ventilation-perfusion mismatch. It is more accurate to describe the intrapulmonary process associated with these vascular dilatations as a diffusion-perfusion abnormality rather than as an intrapulmonary shunt. Hypoxia is believed to result from an inability of oxygen to diffuse to the center of massively dilated peripheral vessels.
Chest radiographs demonstrate basilar nodular or reticulonodular areas of increased opacity in 5%–13.8% of patients with chronic liver disease and 46%–100% of patients with hepatopulmonary syndrome. Lung volumes are preserved. Intrapulmonary arteriovenous shunting can be established with contrast (microbubble) echocardiography, technetium-99m macroaggregated albumin imaging, right-sided heart catheterization, or pulmonary arteriography. Transthoracic contrast echocardiography is performed by injecting contrast material (usually agitated saline) intravenously during echocardiography. Contrast (microbubble) generally appears in the left heart three to eight heart beats after its appearance in the right atrium when intrapulmonary shunt exists.
Computed tomography (CT) may demonstrate dilated vessels with an increased number of terminal branches extending to the pleura and can be useful in distinguishing hepatopulmonary syndrome from other causes of hypoxemia such as pulmonary fibrosis.
- Please refer to
Case 113, Case 195, Case 627, -
KSTR Symposium 1999 Case 5
,
KSTR imaging conference 2017 Spring Case 12,
- References
1. Cris A. Meyer, Charles S. White, Kenneth E.Sherman. Diseases of the Hepatopulmonary Axis RadioGraphics 2009; 29:825–837
2. Tonelli AR, Naal T, Dakkak W, Park MM, Dweik RA, Stoller JK. Assessing the kinetics of microbubble appearance in cirrhotic patients using transthoracic saline contrast-enhanced echocardiography. Echocardiography. 2017;34(10):1439
- Keywords
- lung, vascular, hepatopulmonary Syndrome, liver cirrhosis,