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

Kim, Jung Sun; Kim, Changhwan; Kim, Gye Su; Lim, Dal Soo; Hwang, Hweung Kon; Ro, Young Moo

doi:2009.66.1.47

Tuberc Respir Dis > Volume 66(1); 2009 > Article

Case Report

Tuberculosis and Respiratory Diseases 2009;66(1):47-51.
DOI: https://doi.org/10.4046/trd.2009.66.1.47 Published online January 1, 2009.

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

Jung Sun Kim, Changhwan Kim, Gye Su Kim, Dal Soo Lim, Hweung Kon Hwang, Young Moo Ro

¹Department of Internal Medicine, Korea University College of Medicine, Seoul, Korea.
²Department of Internal Medicine and Sejong Medical Research Institute, Sejong General Hospital, Bucheon, Korea. masque@sejongh.co.kr

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.

Key Words: Hepatopulmonary syndrome, Hypoxemia, Liver cirrhosis, Liver transplantation