Abdominal pain and dyspnea. History of hepatitis C infection and liver cirrhosis.
CT abdomen with contrast
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The liver shows cirrhotic changes manifested as bulky left and caudate lobes. The hepatic veins and IVC are dilated with early contrast filling. Scans through the basal chest show gross cardiomegaly … Features of passive hepatic venous congestion.
Portal hypertension manifested as moderate splenomegaly (16.7cm) with multiple tiny calcific foci (old granulomas),mild to moderate ascites with areas of partial loculation, diffuse mesenteric congestion, dilated portomesenteric venous axis with multiple peri-splenic collaterals..
Basal lung zones show consolidative change of the right middle lobe as well as the lateral segment of the lower lobe. Dilated tortuous vessels within the consolidated right middle lobe … Mostly representing type II hepatopulmonary syndrome.
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.