title: Hepatopulmonary syndrome and venous emboli causing intracerebral hemorrhages after liver transplantation: a case report.
abstract: Increasing experience has fostered the acceptance of liver transplantation as a treatment for patients with hepatopulmonary syndrome. Morbidity and mortality is most commonly attributed to progressive arterial hypoxemia postoperatively. A cerebral hemorrhage has been reported in one patient with hepatopulmonary syndrome after transplantation. However, a postmortem examination of the brain was not performed and the pathogenesis or type of cerebral hemorrhage was undefined. We report on a patient with severe hepatopulmonary syndrome who developed multiple intracranial hemorrhages after transplantation. The intracerebral hemorrhages were most consistent with an embolic etiology on postmortem examination. We postulate that venous embolization, caused by the manipulation of a Swan Ganz catheter in a thrombosed central vein, resulted in pulmonary emboli that passed through dilated intrapulmonary vessels into the cerebral microcirculation. Special attention to central venous catheters and avoidance of manipulation may be warranted in subjects with severe hepatopulmonary syndrome after liver transplantation.
authors.affiliation: Division of Gastroenterology and Hepatology, Liver Center, University of Alabama at Birmingham, 35294-0007, USA.
authors.forename: G A
authors.initials: GA
authors.lastname: Abrams
authors.forename: K
authors.initials: K
authors.lastname: Rose
authors.forename: M B
authors.initials: MB
authors.lastname: Fallon
authors.forename: B M
authors.initials: BM
authors.lastname: McGuire
authors.forename: J R
authors.initials: JR
authors.lastname: Bloomer
authors.forename: D J
authors.initials: DJ
authors.lastname: van Leeuwen
authors.forename: T
authors.initials: T
authors.lastname: Tutton
authors.forename: M T
authors.initials: MT
authors.lastname: Sellers
authors.forename: D E
authors.initials: DE
authors.lastname: Eckhoff
authors.forename: J S
authors.initials: JS
authors.lastname: Bynon
mesh_terms: D002543:Cerebral Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D017809:Fatal Outcome; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000150:complications*; D006801:Humans; D016031:Liver Transplantation; D008875:Middle Aged; D011183:Postoperative Complications; D011655:Pulmonary Embolism / Q000150:complications*; D011667:Pulmonary Veins; D014057:Tomography, X-Ray Computed