Resting Hypoxia and a Strongly Positive Bubble Test: Do Not Forget Hepato-Pulmonary Syndrome.

Abstract

A 40-year-old male presented to the hospital with a tender right calf, right-sided pleuritic chest pain, and haemoptysis. He has a strong family history of anti-thrombin-3 deficiency and unprovoked deep-vein thrombosis in many of his paternal family members. Computed tomography (CT) pulmonary angiography demonstrated a segmental pulmonary embolism (PE) and associated pulmonary haemorrhage/infarct in the right middle lobe (Panel-A). X-ray chest demonstrated mild pulmonary congestion (Panel-B). Resting oxygen saturation on room air (RA) was 81%; disproportionately low for his presentation with PE, however, the patient did not complain of dyspnoea.