Hepatopulmonary syndrome

Case contributed by Dr Mostafa Mahmoud El Feky

Presentation

Abdominal pain and dyspnea. History of hepatitis C infection and liver cirrhosis.

Patient Data

Age: 60
Gender: Male
CT

CT abdomen with contrast

The liver shows cirrhotic changes manifesting as bulky left lobe and slightly irregular contours. The hepatic veins and IVC are dilated with early contrast filling and gross cardiomegaly is seen, suggesting passive hepatic venous congestion. Gallbladder oedema, associated with cirrhosis, is also seen.

Portal hypertension manifests as moderate splenomegaly (16.7cm), mild to moderate ascites with areas of partial loculation, diffuse mesenteric congestion, dilated portomesenteric venous axis and multiple peri-splenic collaterals.

Basal lung zones show consolidation in the right middle lobe as well as the laterobasal segment of the lower lobe. There are dilated tortuous vessels within the consolidated right middle lobe, suggestive of type II hepatopulmonary syndrome.

Case Discussion

Hepatopulmonary syndrome refers to the combination of hepatic dysfunction (cirrhosis), hypoxaemia, peripheral pulmonary arterial dilatation (due to right to left microshunts). The primary condition in this patient is chronic hepatitis C infection with cirrhosis and long standing portal hypertension.

Then he developed dyspnea that was first suggested due to abdominal ascites. Triphasic CT of the liver showed peripheral dilatation of distal pulmonary arteries with nodular pattern. However, pulmonary CTA is not available to exclude pulmonary hypertension in the setting of gross cardiomegaly.

PlayAdd to Share

Case information

rID: 53730
Published: 18th Jun 2017
Last edited: 16th Apr 2018
Inclusion in quiz mode: Included

Updating… Please wait.
Loadinganimation

Alert accept

Error Unable to process the form. Check for errors and try again.

Alert accept Thank you for updating your details.