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Case Reports in HepatologyVolume 2011 2011, Article ID 386709, 3 pages

Case ReportDivision of Gastroenterology, Department of Medicine, Nassau University Medical Center, 2201 Hempstead Turnpike, East Meadow, NY 11554, USA

Received 16 June 2011; Accepted 18 July 2011

Academic Editors: A. Irisawa and D. Lorenzin

Copyright © 2011 Jorge M. Hurtado-Cordovi et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

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.





Autor: Jorge M. Hurtado-Cordovi, Seth Lipka, Jaspreet Singh, Ghulamullah Shahzad, and Paul Mustacchia

Fuente: https://www.hindawi.com/



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