10/11/16 Resident Morning Report – Pulmonary Complications of Liver Disease

CC: 4 months of worsening dyspnea on exertion

ID: 39 yo female with Child’s A alcoholic cirrhosis (MELD 15) complicated by esophageal varices, duodenal varices, ascites, s/p TIPS procedure 3 years ago presents with 4 months of worsening shortness of breath, dyspnea on exertion, and palpitations. Exam was notable for oxygen saturation of 98% on room air, tachycardia, clear lungs bilaterally, digit clubbing, and absence of a fluid wave. Further studies, including TTE and R heart catheterization, revealed she had portopulmonary hypertension. We propose that she likely had hepatopulmonary syndrome as well, which may have improved with her TIPS, and subsequently developed portopulmonary hypertension.

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table in PDF format


Pearls from morning report:

  • Hepatopulmonary Syndrome (HPS) will cause digital clubbing; portopulmonary HTN (POPH) generally will not
  • RVSP < 30 mmHg on TTE essentially rules out POPH

Random trivia:

The first case of hepatopulmonary syndrome was described by Dr. Fluckiger in 1884 after observing a woman with cirrhosis, cyanosis, and clubbed digits.


Want to read more?

Pulmonary Complications in Chronic Liver Disease (Hepatology)
Hepatopulmonary Syndrome – A Liver-Induced Lung Vascular Disorder (NEJM)


References: 

Porres-Aguilar M, Altamirano JT, Torre-Delgadillo A, et al. Portopulmonary hypertension and hepatopulmonary syndrome: a clinician-oriented overview. Eur Respir Rev. 2012;21:125,223-233.

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