Long history of liver cirrhosis with recent onset dyspnea and cyanosis.
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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.
Hepatopulmonary syndrome is characterized clinically by dyspnea, cyanosis, and clubbing in a cirrhotic patient. There are two types of findings in hepatopulmonary syndrome:
- 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.
- 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.