Cirrhosis-related intrathoracic disease. Imaging features in 1038 patients.
OBJECTIVE
To describe imaging features of cirrhosis-related intrathoracic disease.


METHODS
Chest CTs of 1038 cirrhotic patients (mean age 53 yrs; range, 17-79) were evaluated for: bronchoarterial ratio (BAR), arteriovenous malformations, interstitial opacities, emphysema, and pleural effusions. Lymphangiography, pulmonary angiography, cardiac ultrasound and scintigraphy were selectively performed.


RESULTS
Mean BAR was 0.83+/-0.19. In two patients with hepatopulmonary syndrome (HPS), mean BAR was 0.55. HRCT detected interstitial lung opacities in 15 patients. Signs of fibrosis were seen in 7 (only two associated to biliary cirrhosis) and interstitial edema in 8. Accurate pattern recognition was achieved in 10/15 cases (66.6%). Of the 93 patients with emphysema only one had documented alpha1-AT deficiency (1.08%). Multiple type 1 vascular dilatations were visualized in two patients with HPS. Hepatic hydrothorax was present in 49 patients (4.72%); right-sided in 34 (69.4%), bilateral in 9 (18.4%) and left-sided in 6 (12.2%). Hepatic chylothorax was confirmed in 3 patients. Lymphangiography demonstrated the site of leakage and the engorged thoracic duct.


CONCLUSIONS
CT can identify intrathoracic pathology associated with liver disease. Decreased BAR is highly specific for HPS. However, a multimodality approach is necessary to depict cases of liver origin.
Malagari
K
K
2nd Department of Radiology, Medical School, University of Athens, Greece. kmalag@acn.gr
Nikita
A
A
Alexopoulou
E
E
Brountzos
E
E
Papathanasiou
M
M
Mitromaras
J
J
Zakynthinos
E
E
Papiris
S
S
Kelekis
D A
DA
D000293:Adolescent; D000328:Adult; D000368:Aged; D000792:Angiography; D001160:Arterioles / Q000000981:diagnostic imaging; D001980:Bronchi / Q000098:blood supply; D020065:Hepatopulmonary Syndrome / Q000000981:diagnostic imaging; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications*; D008875:Middle Aged; D013902:Radiography, Thoracic; D011877:Radionuclide Imaging; D013896:Thoracic Diseases / Q000175:diagnosis* / Q000209:etiology*; D014057:Tomography, X-Ray Computed / Q000379:methods; D014463:Ultrasonography