title: The hepatopulmonary syndrome: radiologic findings in 10 patients.
abstract: OBJECTIVE
  The purpose of this study was to review the radiologic manifestations of the hepatopulmonary syndrome.
  
  
  METHODS
  We retrospectively reviewed clinical records, chest radiographs, 99m Tc-macroaggregated albumin (MAA) perfusion lung scans, chest CT scans, and pulmonary angiograms of 10 patients with proven hepatopulmonary syndrome.
  
  
  RESULTS
  Chest radiographs showed basilar, medium-sized (1.5-3.0 mm) nodular or reticulonodular opacities in all cases. CT was done in eight cases and showed basilar dilatation of lung vessels with a larger than normal number of visible branches. The vascular basis for these opacities was best appreciated on conventional CT scans of 10-mm sections. No individual arteriovenous malformations were seen on CT scans. High-resolution CT scans showed no evidence of interstitial fibrosis. 99mTc-MAA perfusion lung imaging, done in seven patients, showed pulmonary arteriovenous shunting in five. Contrast echocardiography confirmed intrapulmonary shunting in these five patients. Pulmonary angiography, done in four cases, showed subtle distal vascular dilatation in two and moderate dilatation with early venous filling in two but did not reveal any individual arteriovenous malformations.
  
  
  CONCLUSIONS
  Chest radiographs in hepatopulmonary syndrome usually show bibasilar nodular or reticulonodular opacities. Conventional CT shows that these opacities represent dilated lung vessels. High-resolution CT is useful in excluding pulmonary fibrosis or emphysema as the cause of these opacities. 99mTc-MMA perfusion imaging or contrast echocardiography can be used to confirm intrapulmonary arteriovenous shunting.
authors.affiliation: Department of Radiology, Duke University Medical Center, Durham, NC 27710, USA.
authors.forename: H P
authors.initials: HP
authors.lastname: McAdams
authors.forename: J
authors.initials: J
authors.lastname: Erasmus
authors.forename: R
authors.initials: R
authors.lastname: Crockett
authors.forename: J
authors.initials: J
authors.lastname: Mitchell
authors.forename: J D
authors.initials: JD
authors.lastname: Godwin
authors.forename: V G
authors.initials: VG
authors.lastname: McDermott
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis; D008168:Lung / Q000000981:diagnostic imaging; D008171:Lung Diseases / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011859:Radiography; D011877:Radionuclide Imaging; D012189:Retrospective Studies; D013577:Syndrome; D013668:Technetium Tc 99m Aggregated Albumin
chemical_list: D013668:Technetium Tc 99m Aggregated Albumin