title: [Dyspnea in a 45-year-old man with liver cirrhosis].
abstract: METHODS
  During evaluation for a liver transplantation in a 45-year-old man with alcoholic liver he complained of exertional dyspnea. He had grade 3 chronic obstructive pulmonary disease (COPD) after nicotine abuse of 50 pack-years. One and a half years earlier the patient had been treated for tuberculosis.
  
  
  METHODS
  The diagnostic procedures showed a respiratory insufficiency with a PO(2) of 52 mm Hg. Notable was a missing improvement of oxygenation after the supply of 100 % oxygen. Lung perfusion scintigraphy showed a shunt of about 14 %, a contrast-medium echocardiography demonstrating a right-to-left shunt. These findings indicated that the patient had a hepatopulmonary syndrome.
  
  
  METHODS
  The only causal therapy of a hepatopulmonary syndrome was a liver transplantation. However, the tuberculosis diagnosed one and a half years earlier had not been treated adequately, so that an antituberculotic therapy was essential before starting an immunosuppression. Therefore the only option of treatment was to continue the long-term oxygen therapy. As a matter of differential diagnosis and because of the intrapulmonary shunt, a pulmonary venous disconnection for a shunt caused by tuberculous cavities or by the COPD had to be taken into account.
  
  
  CONCLUSIONS
  Treating patients with advanced liver cirrhosis and dyspnea a hepatopulmonary syndrome must be taken into consideration. Typically there will be found a right-left-shunt. In addition, coexistent comorbidities as a reason for dyspnea have to be excluded.
authors.affiliation: Pneumologie und Beatmungsmedizin, Thoraxklinik am Universitätsklinikum Heidelberg, Heidelberg. philine.kaukel@thoraxklinik-heidelberg.de
authors.forename: P
authors.initials: P
authors.lastname: Kaukel
authors.forename: H
authors.initials: H
authors.lastname: Wenz
authors.forename: M
authors.initials: M
authors.lastname: Wiebel
authors.forename: C-P
authors.initials: CP
authors.lastname: Heussel
authors.forename: F J
authors.initials: FJ
authors.lastname: Herth
authors.forename: M
authors.initials: M
authors.lastname: Kreuter
mesh_terms: D004417:Dyspnea / Q000209:etiology*; D020065:Hepatopulmonary Syndrome / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D010102:Oxygen Inhalation Therapy; D029424:Pulmonary Disease, Chronic Obstructive / Q000175:diagnosis / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome; D014376:Tuberculosis / Q000150:complications*