scholarly journals Diagnostic Challenge of Hepatopulmonary Syndrome in a Patient with Coexisting Structural Heart Disease

2011 ◽  
Vol 2011 ◽  
pp. 1-3 ◽  
Author(s):  
Jorge M. Hurtado-Cordovi ◽  
Seth Lipka ◽  
Jaspreet Singh ◽  
Ghulamullah Shahzad ◽  
Paul Mustacchia
Keyword(s):  
Liver Disease ◽  
Ventral Hernia ◽  
White Male ◽  
Hepatopulmonary Syndrome ◽  
Structural Heart Disease ◽  
Foramen Ovale ◽  
Diagnostic Challenge ◽  
Breath Sounds ◽  
History Of ◽  
Cirrhotic Patients

Hepatopulmonary syndrome (HPS) is a severe complication seen in advance liver disease. Its prevalence among cirrhotic patients varies from 4–47 percent. HPS exact pathogenesis remains unknown. Patient presents with signs/symptoms of chronic liver disease, and dypsnea of variable severity. Our patient is a 62 years old white male with a known history of chronic hepatitis C, cirrhosis, ascites, and hypothyroidism who presented to GI/liver clinic complaining of 1 episode BRBPR, and exacerbating dypsnea associated with nausea and few episodes of non-bloody vomit. Physical exam showed, icterus, jaundice, few small spider angiomas on the chest, decrease breath sounds bilateral right more than left, and mild tachycardic. Abdominal exam revealed mid-line scar, moderated size ventral hernia, distention, diffused tenderness, and dullness to percussion. Laboratory result: CBC 5.2/13.2/37.6/83, LFTs 83/217/125/5.2/4.7/7.4, Pt 22.6 INR 1.9 PTT35.4. CT scan showed liver cirrhosis, abdominal varices, and moderated ascites collection around ventral hernia. Calculated A-a gradient was 49.5. Echocardiography revealed patent foramen ovale (PFO) with predominant left to right shunt. In our case, existence of paten foramen ovale (PFO) and atelectasis precludes definitive diagnosis of HPS. Presence of cardiopulmonary shunt could be partially responsible for the patient’s dypsnea exacerbation.

scholarly journals Chronic Hepatitis C with Cyanosis

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Mahmood Alawainati ◽  
Jawad Khamis ◽  
Muneer Abdulla ◽  
Saeed Alsaeed
Keyword(s):  
Pulmonary Embolism ◽  
Chronic Hepatitis ◽  
Liver Disease ◽  
Hepatitis C ◽  
Liver Transplant ◽  
Chronic Hepatitis C ◽  
Hepatopulmonary Syndrome ◽  
History Of ◽  
Transplant Candidates ◽  
One Year

Background. There are multiple aetiologies for dyspnea in patients with liver disease, including pneumonia, pulmonary embolism, hepatic hydrothorax, portopulmonary syndrome, and hepatopulmonary syndrome. The aim of this paper is to emphasize the importance of early diagnosis and management of hepatopulmonary syndrome. Case Presentation. We report a case of a 65-year-old male who was known to have chronic hepatitis C presented with one-year history of shortness of breath and cyanosis. The initial impression of pulmonary embolism was excluded by comprehensive diagnostic investigations. The correlation between the clinical picture and investigations raised the possibility of hepatopulmonary syndrome which was confirmed by contrast-enhanced transthoracic echocardiography. Conclusions. High suspicion is required to diagnose hepatopulmonary syndrome in patients with liver disease and hypoxemia. Screening for this complication is appropriate in liver transplant candidates, and diagnosed patients should be evaluated extensively for liver transplant.

scholarly journals A case of orthodeoxia platypnoea in a patient with adult polycystic kidney and liver disease with a patent foramen ovale

2007 ◽  
Vol 6 (3) ◽  
pp. 126-127
Author(s):  
Jennifer Graves ◽  
◽  
Martina Mason ◽  
Diane Laws ◽  
◽  
...  
Keyword(s):  
Liver Disease ◽  
Patent Foramen Ovale ◽  
Inferior Vena ◽  
Vena Cava ◽  
Liver Cyst ◽  
Shortness Of Breath ◽  
Foramen Ovale ◽  
Polycystic Kidney ◽  
History Of ◽  
Atrial Shunt

We describe a case of a patient with polycystic kidney and liver disease presenting with a 4 year history of shortness of breath. This was caused by a liver cyst pressing on the inferior vena cava, right atrium and ventricle, leading to a right to left shunt across a patent foramen ovale. This is consistent with the condition Orthodeoxia Platypnoea, which occurs when desaturation and dyspnoea occur in the upright position in association with an intra atrial shunt.

The Impact of Hypoxaemia on the Outcome in Liver Cirrhosis Andrei

2016 ◽  
Vol 25 (4) ◽  
pp. 481-487 ◽  
Author(s):  
Andrei Mihai Voiosu ◽  
Theodor Alexandru Voiosu ◽  
Bianca Smarandache ◽  
Aurelia Rădoi ◽  
Radu Bogdan Mateescu ◽  
...  
Keyword(s):  
Risk Factor ◽  
Liver Disease ◽  
Oxygen Tension ◽  
Arterial Oxygen Tension ◽  
Hepatopulmonary Syndrome ◽  
Arterial Oxygen ◽  
Arterial Blood ◽  
Cirrhotic Patients ◽  
The Impact

Background & Aims: Prognostic factors for poor evolution are critical in the setting of limited access to liver transplantation for patients with cirrhosis. We aimed to investigate the impact of hypoxaemia on the outcome in cirrhosis and the evolution of arterial oxygen tension during long-term follow-up in these patients. Methods: Consecutive cirrhotic patients were prospectively enroled and followed-up in our tertiary referral center. Clinical features, biological tests, arterial blood gases, NT-proBNP levels, pulse oximetry measurements, 12-lead ECG, and transthoracic contrast echocardiography were documented on enrolment. The main outcomes were death and decompensation due to liver disease. Results: 87 cirrhotic patients were included in the analysis and followed-up for a mean of 16 months. At enrolment, 27 (31%) patients were hypoxaemic, 19 had hepatopulmonary syndrome (HPS), but only 6 of those who were sampled at follow-up had persistent hypoxaemia. During the study period, 22 patients died of liver-related complications. Nine of them (41%) were hypoxaemic on enrolment but none had severe hypoxaemia. Hypoxaemia present at enrollment was not a risk factor for death (p=0.29) or decompensation of liver disease (p=0.7). A higher MELD score at baseline or increase during follow-up was a risk factor for death (p=0.02) and correlated with the presence of hypoxaemia. Normalization of the arterial oxygen levels was accompanied by a significant decrease in NT-proBNP (83 pg/ml vs 0 pg/mL, p=0.023). Conclusion: Mild and moderate hypoxaemia was frequent in our patients but was not associated with adverse outcome in cirrhosis. Repeated arterial blood gas sampling is advisable, especially in patients diagnosed with hepatopulmonary syndrome. Abbreviations: AaO2: alveolar-arterial oxygen gradient; IPVDs: intrapulmonary vascular dilations; HBV: hepatitis B virus; HCV: hepatitis C virus; HPS: hepatopulmonary syndrome; MELD: model for end-stage liver disease; NT-proBNP: aminoterminal pro-brain natriuretic peptide; PaCO2: arterial carbon dioxide tension; PaO2: arterial oxygen tension.

Natural history of the progression of liver disease in cirrhotic patients

2000 ◽  
Vol 32 ◽  
pp. A111
Author(s):  
G. Nicolini ◽  
S. Angeloni ◽  
O. Riggio ◽  
A.F. Attili ◽  
M. Merli
Keyword(s):  
Liver Disease ◽  
Natural History ◽  
History Of ◽  
Cirrhotic Patients

scholarly journals Renal thrombotic microangiopathy in an ANCA-associated vasculitis

2019 ◽  
Vol 8 (4) ◽  
pp. 40-40
Author(s):  
Ana Teresa Domingos ◽  
Sara Barreto ◽  
Eduarda Carias ◽  
Ana Cabrita ◽  
Helena Viana ◽  
...  
Keyword(s):  
Thrombotic Microangiopathy ◽  
White Male ◽  
Specific Treatment ◽  
Histological Finding ◽  
Vascular Involvement ◽  
Diagnostic Challenge ◽  
Anca Associated Vasculitis ◽  
Clinical Presentations ◽  
History Of ◽  
Rapidly Progressive Renal Failure

Anti-neutrophil cytoplasmic antibody (ANCA) disease remains a diagnostic challenge due to the heterogeneity of possible clinical presentations. We present the case of a 63-year-old white male with a known history of ANCA-associated vasculitis (AAV) with anti-myeloperoxidase antibodies (MPO) – mainly with respiratory manifestations – treated with corticosteroids and cyclophosphamide, resulting in partial improvement. Six months later he was referred to the nephrology department for rapidly progressive renal failure and a kidney biopsy was performed, which showed several glomeruli globally sclerosed and others presenting fibrous crescents. Vascular involvement was also noted with several small arteries revealing endothelial swelling and entrapped erythrocytes within a fibrin thrombus. Immunofluorescence was negative. A high percentage of parenchymal fibrosis and no evidence of active extra-renal manifestations dictated no specific treatment. The patient is currently monitored in a low clearance nephrology consultation. Evidence of thrombotic microangiopathy (TMA) is an uncommon histological finding in kidney biopsies of patients with AAV, being associated with worst prognosis.

Hereditary Heparin Cofactor II Deficiency and the Risk of Development of Thrombosis

1987 ◽  
Vol 57 (02) ◽  
pp. 196-200 ◽  
Author(s):  
R M Bertina ◽  
I K van der Linden ◽  
L Engesser ◽  
H P Muller ◽  
E J P Brommer
Keyword(s):  
Liver Disease ◽  
Venous Thrombosis ◽  
Healthy Volunteers ◽  
Mean Value ◽  
Age Group ◽  
Normal Range ◽  
Heparin Cofactor Ii ◽  
History Of ◽  
Group 2 ◽  
Hereditary Nature

SummaryHeparin cofactor II (HC II) levels were measured by electroimmunoassay in healthy volunteers, and patients with liver disease, DIC, proteinuria or a history of venous thrombosis. Analysis of the data in 107 healthy volunteers revealed that plasma HC II increases with age (at least between 20 and 50 years). HC II was found to be decreased in most patients with liver disease (mean value: 43%) and only in some patients with DIC. Elevated levels were found in patients with proteinuria (mean value 145%). In 277 patients with a history of unexplained venous thrombosis three patients were identified with a HC II below the lower limit of the normal range (60%). Family studies demonstrated hereditary HC II deficiency in two cases. Among the 9 heterozygotes for HC II deficiency only one patient had a well documented history of unexplained thrombosis. Therefore the question was raised whether heterozygotes for HC II deficiency can also be found among healthy volunteers. When defining a group of individuals suspected of HC II deficiency as those who have a 90% probability that their plasma HC II is below the 95% tolerance limits of the normal distribution in the relevant age group, 2 suspected HC II deficiencies were identified among the healthy volunteers. In one case the hereditary nature of the defect could be established.It is concluded that hereditary HC II deficiency is as prevalent among healthy volunteers as in patients with thrombotic disease. Further it is unlikely that heterozygosity for HC II deficiency in itself is a risk factor for the development of venous thrombosis.

Urokinase Antigen in Plasma of Patients with Liver Cirrhosis and Hepatoma

1985 ◽  
Vol 54 (03) ◽  
pp. 617-618 ◽  
Author(s):  
J C Kirchheimer ◽  
K Huber ◽  
P Polterauer ◽  
B R Binder
Keyword(s):  
Liver Cirrhosis ◽  
Liver Disease ◽  
Liver Function ◽  
Matched Control ◽  
Malignant Growth ◽  
Control Groups ◽  
Impaired Liver Function ◽  
Impaired Liver ◽  
Specific Medication ◽  
History Of

SummaryPlasma urokinase antigen levels were studied in 78 patients suffering from liver diseases. Blood was drawn before any specific medication was initiated. Impairment of liver function was comparable in all patients. In both groups of cirrhotic liver disease (alcoholic and non-alcoholic), normal levels of plasma urokinase antigen were found as compared to age-matched control groups. In both groups of patients with hepatomas (with or without a history of liver cirrhosis), however, significantly increased plasma urokinase antigen levels could be determined. These data indicate that an increase in plasma urokinase antigen might rather relate to malignant growth in liver disease than to impaired liver function.

An unusual presentation of epigastric pain due to thrombophlebitis of a recanalised umbilical vein – case report

2019 ◽  
Vol 98 (8) ◽  
pp. 326-327 ◽  
Keyword(s):  
Liver Cirrhosis ◽  
Abdominal Pain ◽  
Case Report ◽  
Portal Hypertension ◽  
Liver Disease ◽  
Epigastric Pain ◽  
Umbilical Vein ◽  
History Of ◽  
Clinically Significant ◽  
Inflammatory Changes

Introduction: The umbilical vein can become recanalised due to portal hypertension in patients with liver cirrhosis but the condition is rarely clinically significant. Although bleeding from this enlarged vein is a known complication, the finding of thrombophlebitis has not been previously described. Case report: We report the case of a 62-year-old male with a history of liver cirrhosis due to alcoholic liver disease presenting to hospital with epigastric pain. A CT scan of the patient’s abdomen revealed a thrombus with surrounding inflammatory changes in a recanalised umbilical vein. The patient was managed conservatively and was discharged home the following day. Conclusion: Thrombophlebitis of a recanalised umbilical vein is a rare cause of abdominal pain in patients with liver cirrhosis.

Refractory Ascites as the Only Presenting Symptom of Chronic Calcified Constrictive Pericarditis: A Diagnostic Challenge

2014 ◽  
Vol 17 (1) ◽  
pp. 42
Author(s):  
Shi-Min Yuan
Keyword(s):  
Computed Tomography ◽  
Liver Cirrhosis ◽  
Female Patient ◽  
Constrictive Pericarditis ◽  
Delayed Diagnosis ◽  
Young Female ◽  
Refractory Ascites ◽  
Diagnostic Challenge ◽  
Massive Ascites ◽  
History Of

Extracardiac manifestations of constrictive pericarditis, such as massive ascites and liver cirrhosis, often cover the true situation and lead to a delayed diagnosis. A young female patient was referred to this hospital due to a 4-year history of refractory ascites as the only presenting symptom. A diagnosis of chronic calcified constrictive pericarditis was eventually established based on echocardiography, ultrasonography, and computed tomography. Cardiac catheterization was not performed. Pericardiectomy led to relief of her ascites. Refractory ascites warrants thorough investigation for constrictive pericarditis.

A Rare Case of Bilateral Incarcerated Obturator Hernias and a Right-Side Femoral Hernia

2020 ◽  
pp. 1-3
Author(s):  
Jinping Xu ◽  
Jinping Xu ◽  
Ruth Wei ◽  
Salieha Zaheer
Keyword(s):  
Emergency Department ◽  
Abdominal Pain ◽  
Femoral Hernia ◽  
Rare Case ◽  
Hernia Recurrence ◽  
High Morbidity ◽  
Diagnostic Challenge ◽  
Abdominal Ct ◽  
Abdominal Ct Scan ◽  
History Of

Obturator hernias are rare but pose a diagnostic challenge with relatively high morbidity and mortality. Our patient is an elderly, thin female with an initial evaluation concerning for gastroenteritis, and further evaluation revealed bilateral incarcerated obturator hernias, which confirmed postoperatively as well as a right femoral hernia. An 83-year-old female presented to the outpatient office initially with one-day history of diarrhea and one-week history of episodic colicky abdominal pain. She returned 4 weeks later with diarrhea resolved but worsening abdominal pain and left inner thigh pain while ambulating, without changes in appetite or nausea and vomiting. Abdominal CT scan then revealed bilateral obturator hernias. Patient then presented to the emergency department (ED) due to worsening pain, and subsequently underwent hernia repair. Intraoperatively, it was revealed that the patient had bilateral incarcerated obturator hernias and a right femoral hernia. All three hernias were repaired, and patient was discharged two days later. Patient remained well postoperatively, and 15-month CT of abdomen showed no hernia recurrence.

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