Hepatopulmonary syndrome

Case contributed by Dr Heba Mohamed

Presentation

Long history of liver cirrhosis with recent onset dyspnea and cyanosis.

Patient Data

Age: 65 years
Gender: Male
CT

The lower chest cuts demonstrate multiple subpleural slightly-dilated vasculature that does not taper, more pronounced at the lower lobe of the right lung. The liver is cirrhotic, the spleen is enlarged with dilated portosystemic collateral pathways.

Normal caliber of the pulmonary artery. No pleural effusion.

Case Discussion

Hepatopulmonary syndrome is characterized clinically by dyspnea, cyanosis, and clubbing in a cirrhotic patient. There are two types of findings in hepatopulmonary syndrome:

  1. Type 1 is the most common and characterized by distal dilatation of the vascular tree mostly, in CT   dilated subpleural vessels that do not narrow peripherally normally and therefore reaches the pleural surface.
  2. Type 2 hepatopulmonary syndrome usually seen as localized nodular dilatation of peripheral pulmonary vessels on CT scans.

Based on the previous discussion our case may fit in type I hepatopulmonary syndrome.

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Case information

rID: 59570
Published: 15th Apr 2018
Last edited: 19th Apr 2018
Inclusion in quiz mode: Included
Institution: Zagazig University Hospital

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