Hepatopulmonary syndrome in a patient with end-stage liver disease:
(Case submitted by Dr. Marc Cote, D.O.)The middle aged male patient with end-stage liver disease shown below complained of increasing shortness of breath and had an A-A gradient on arterial blood gas analysis. A ventilation-perfusion scan was performed to exclude pulmonary embolism.
The Tc-MAA exam demonstrated heterogeneous pulmonary perfusion and the presence of right to left shunting as evidenced by renal, hepatic, splenic, and cerebral activity. The findings and clinical history were considered diagnostic of hepatopulmonary syndrome.
