title: Echocardiographic detection of intrapulmonary shunting in a patient with hepatopulmonary syndrome: case report and review of the literature.
abstract: Transthoracic echocardiography is a useful tool in the evaluation of patients with intrapulmonary and intracardiac shunts. We describe a case of a 49-year-old female with severe hypoxemia in the setting of aortic stenosis and cirrhosis of the liver. The use of agitated saline contrast during an echocardiography study helped to establish the diagnosis of intrapulmonary arteriovenous shunting consistent with the hepatopulmonary syndrome, thereby confirming the etiology of her symptoms and laboratory findings. This case report highlights the utility of echocardiography in diagnosing intrapulmonary shunts and assists in the understanding of the pathophysiology of hypoxemia in such patients.
authors.affiliation: Division of Cardiology, Department of Medicine, Tufts-New England Medical Center, Boston, Massachusetts 02111, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Pacca
authors.forename: Prasad
authors.initials: P
authors.lastname: Maddukuri
authors.forename: Natesa G
authors.initials: NG
authors.lastname: Pandian
authors.forename: Jeffrey T
authors.initials: JT
authors.lastname: Kuvin
mesh_terms: D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography; D005260:Female; D020065:Hepatopulmonary Syndrome / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008875:Middle Aged; D009542:Niemann-Pick Diseases / Q000150:complications; D011652:Pulmonary Circulation