Hypoxemia… and if it is the liver? Hepatopulmonary syndrome : about a case

##plugins.themes.academic_pro.article.sidebar##

Published Sep 27, 2023
Download
pdf
Vol. 101 No. 5 (2023): Tunis med may 2023

##plugins.themes.academic_pro.article.main##

Sabrine Majdoub Fehri
Department of Pneumology, Gabes Teaching Hospital, Faculty of Medicine of Sfax, University of Sfax, Tunisia.
Wafa Fekih
Department of Pneumology, Gabes Teaching Hospital, Faculty of Medicine of Sfax, University of Sfax, Tunisia.
Mohamed Khrouf
Department of Pneumology, Gabes Teaching Hospital, Faculty of Medicine of Sfax, University of Sfax, Tunisia.
Hamida Kwas
Department of Pneumology, Gabes Teaching Hospital, Faculty of Medicine of Sfax, University of Sfax, Tunisia.
Hichem Denguir
Department of Cardiology, Gabes Teaching Hospital, Faculty of Medicine of Sfax, University of Sfax, Tunisia.

Abstract

The hepatopulmonary syndrome is defined as the triad of liver disease, pulmonary gas exchange abnormalities leading to arterial deoxygenation and widespread pulmonary vascular dilatation. It is one of the not infrequently cases of dyspnea within patients with liver disease. We report the case of a 32-year-old woman with cirrohsis and portal hypertention who presented with dyspnea worsning progressively. The blood gas revealed a deep hypoxemia with a PaO2 rate 42mmHg but clinically well tolerated. Pulmonary embolism and pneumonia were rapidly excluded by a CT pulmonary angiography. An echocadiography done in order to find any heart disease suspected a patent foramen ovale. A transthoracic contrast echocardiography showed an important pulmonary vascular dilatation.The association of cirrohsis, pulmonary vascular dilatation and hypoxemia made the diagnos of hepatopulmonary syndrome.

Keywords:

Hepatopulmonary syndrome, Hypoxemia, Cirrohsis, Pulmonary vascular dilatation

##plugins.themes.academic_pro.article.details##

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

References

  1. Netgen. Le syndrome hépatopulmonaire (SHP) [Internet]. Revue Médicale Suisse. [cité 20 févr 2020]. Disponible sur: https://www.revmed.ch/RMS/2003/RMS-2458/23390
  2. Thevenot T, Pastor C-M, Cervoni J-P, Jacquelinet C, Nguyen-Khac E, Richou C, et al. Le syndrome hépatopulmonaire. Gastroentérologie Clinique et Biologique. 1 juin 2009;33(6):565‑79.
  3. Robert V, Chabot F, Vial B, Guiot P. Syndrome hépatopulmonaire. 2020;11.
  4. Rodríguez-Roisin R, Krowka MJ, Hervé P, Fallon MB. Pulmonary–Hepatic vascular Disorders (PHD). European Respiratory Journal. 1 nov 2004;24(5):861‑80.
  5. Marcu DC, Schiffer E, Aubert J-D, Vionnet J, Yerly P, Deltenre P. Syndrome hépato-pulmonaire et hypertension porto-pulmonaire. REVUE MÉDICALE SUISSE. 2017;7.
  6. Machicao VI, Balakrishnan M, Fallon MB. Pulmonary complications in chronic liver disease. Hepatology. avr 2014;59(4):1627‑37.
  7. Raevens S, Geerts A, Van Steenkiste C, Verhelst X, Van Vlierberghe H, Colle I. Hepatopulmonary syndrome and portopulmonary hypertension: recent knowledge in pathogenesis and overview of clinical assessment. Liver Int. juin 2015;35(6):1646‑60.
  8. Swanson KL, Wiesner RH, Krowka MJ. Long-term survival in hepatopulmonary syndrome. (Pulmonary vascular and thromboembolic disorders: 12:00pm-1:45pm). Chest. 1 oct 2002;122(4):210S-210S.
  9. Schraufnagel DE, Malik R, Goel V, Ohara N, Chang SW. Lung capillary changes in hepatic cirrhosis in rats. Am J Physiol. janv 1997;272(1 Pt 1):L139-147.
  10. Gómez FP, Martínez-Pallí G, Barberà JA, Roca J, Navasa M, Rodríguez-Roisin R. Gas exchange mechanism of orthodeoxia in hepatopulmonary syndrome. Hepatology. sept 2004;40(3):660‑6.
  11. Thevenot T, Pastor C-M, Cervoni J-P, Jacquelinet C, Nguyen-Khac E, Richou C, et al. Le syndrome hépatopulmonaire. Gastroentérologie Clinique et Biologique. juin 2009;33(6‑7):565‑79.
  12. Krowka MJ, Dickson ER, Cortese DA. Hepatopulmonary syndrome. Clinical observations and lack of therapeutic response to somatostatin analogue. Chest. août 1993;104(2):515‑21.
  13. Rodriguez-Roisin R, Roca J, Agusti AG, Mastai R, Wagner PD, Bosch J. Gas exchange and pulmonary vascular reactivity in patients with liver cirrhosis. Am Rev Respir Dis. mai 1987;135(5):1085‑92.
  14. McAdams HP, Erasmus J, Crockett R, Mitchell J, Godwin JD, McDermott VG. The hepatopulmonary syndrome: radiologic findings in 10 patients. AJR Am J Roentgenol. juin 1996;166(6):1379‑85.
  15. Lange PA, Stoller JK. The hepatopulmonary syndrome. Effect of liver transplantation. Clin Chest Med. mars 1996;17(1):115‑23.