Abstract
Objectives:The diagnosis of hepatopulmonary syndrome (HPS) which is a common complication in cirrhotic patients is still subject to debate. This study investigated the association of clinical findings with HPS in cirrhotic patients using macro-aggregated albumin lung perfusion scan (99mTc-MAA lung scintigraphy). In addition, comparison between 99mTc-MAA lung scintigraphy and contrast echocardiography (CEE) in detection of HPS was also performed.Methods:In this study, 27 patients with cirrhosis underwent 99mTc-MAA lung scintigraphy and contrast echocardiography comparison CEE and the frequency of HPS was assessed in them and also was compared across the other variables.Results:The 99mTc-MAA lung scintigraphy showed HPS in 13 patients (48.1%) while CEE demonstrated HPS in 5 patients with cirrhosis (18.51%). HPS was mild in 40.74% (11/27) of the patients, and severe in only 2 patients. There was no relationship between gender, disease duration, having diagnosis of disease previously, pulmonary symptoms and Child-Pugh score variations and HPS (p>0.05). Comparison of hemodynamic indices, arterial blood gas analysis and laboratory indices between patients with and without HPS was also non-significant (p value >0.05). Among coagulation factors assessed in cirrhotic patients, we found only significant correlation between HPS and prothrombin time (p<0.05).Conclusion:HPS, particularly its mild form, is noted in a great number of patients with cirrhosis using 99mTc-MAA lung scintigraphy. Because of its technical ease, and possibility to obtain objective quantitative information, 99mTc-MAA lung scintigraphy can be complementary to other diagnostic methods in the evaluation of HPS assessment, although additional studies are needed.
Highlights
Cirrhosis is a pathologic process in which normal liver structure is substituted by scar tissue
We evaluated cirrhotic patients to find the frequency of hepatopulmonary syndrome (HPS) in these patients with assistance of clinical and paraclinical methods
Signs of HPS are dyspnea, platypnea and orthodeoxia and HPS is diagnosed with a clinical triad including chronic liver disease, increased alveolar-arterial gradient of O2 [p (A-a) O2] ≥15 mmHg (≥20 mmHg for patients over 64 years) and the presence of intrapulmonary right to left shunt [9,10,11]
Summary
Cirrhosis is a pathologic process in which normal liver structure is substituted by scar tissue. Cirrhotic patients are vulnerable to many side effects that reduce their lifetime. One of these side effects is hypoxia resulting from hepatopulmonary syndrome (HPS) [1,2,3]. HPS, which can influence patient’s prognosis, is described by a clinical triad entailing being of late stage liver disease, gas exchange disorders, eventually leading to hypoxemia and the occurrence of intrapulmonary vascular dilatations (IPVD), without being of intrinsic pulmonary disease [4]. Many conditions can influence the gas exchange in lungs [5]. Some side effects of cirrhosis such as HPS or portopulmonary hypertension may not be diagnosed by physical examination, pulmonary imaging modalities or pulmonary function tests [6]
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