Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome.
OBJECTIVE
Two modalities, contrast echocardiography and lung perfusion scan, are used to identify intrapulmonary vascular dilatation and diagnose hepatopulmonary syndrome (HPS), but a comparison of these two procedures has not been performed. The aim of this study was to compare the use of these diagnostic modalities in detecting intrapulmonary vascular dilatation and diagnosing HPS.


METHODS
Forty consecutive outpatients with biopsy-proven cirrhosis had contrast echocardiography, a lung perfusion scan, and arterial blood gases analyzed.


RESULTS
Fifteen of 40 cirrhotics (38%) had positive contrast echocardiogram results. Seven patients with positive echocardiogram results had gas exchange abnormalities and could be considered to have HPS (7 of 40 [17.5%]). Three of these patients were hypoxemic and had no concurrent cardiopulmonary disease, and each had positive contrast echocardiogram and lung perfusion scan results and were readily diagnosed as having HPS. The other 4 patients (3 hypoxemic and 1 normoxemic with an elevated alveolar-arterial gradient) had coexisting intrinsic lung disease and/or chest radiograph abnormalities complicating the diagnosis of HPS, and each had positive echocardiogram and negative lung scan results. The remaining 8 patients with positive echocardiogram results had normal lung scan and normal gas exchange results. No patient had positive lung scan and negative contrast echocardiogram results.


CONCLUSIONS
Contrast echocardiography is the most useful screening test for intrapulmonary vasodilatation and may be positive more frequently than lung perfusion scans in patients with HPS.
Abrams
G A
GA
Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut, USA.
Jaffe
C C
CC
Hoffer
P B
PB
Binder
H J
HJ
Fallon
M B
MB
D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008107:Liver Diseases / Q000175:diagnosis*; D008168:Lung / Q000000981:diagnostic imaging*; D008171:Lung Diseases / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D011877:Radionuclide Imaging; D013577:Syndrome