title: Coil embolization of pulmonary arteries as a palliative treatment of diffuse type I hepatopulmonary syndrome.
abstract: Hepatopulmonary syndrome is a serious complication of liver disease. Type I hepatopulmonary syndrome is associated with diffuse dilatation of the pulmonary vasculature, leading to severe hypoxemia. Liver transplantation is the treatment of choice for this condition. There are limited options for those who are not candidates for liver transplantation. We present the case of a patient who presented with severe hypoxemia requiring FIO2 of 0.95 with PaO2 of 59 mm Hg. Workup revealed 33% intrapulmonary right-to-left shunt. A pulmonary angiogram showed diffuse dilatation of the pulmonary arteries, especially in the lower lobes. The patient was diagnosed with type I hepatopulmonary syndrome. He was not a candidate for liver transplantation. The patient underwent sequential coil embolizations of the lower lobe pulmonary arteries. He was discharged home on 2 L of supplemental oxygen. This case demonstrates that coil embolization of dilated pulmonary arteries is a potential palliative treatment for patients with diffuse type I hepatopulmonary syndrome.
authors.affiliation: Division of Pulmonary & Critical Care and Sleep Medicine.
authors.forename: Kimberley
authors.initials: K
authors.lastname: Grady
authors.affiliation: Division of Pediatric Cardiology, Wayne State University School of Medicine, Detroit, Michigan.
authors.forename: Srinath
authors.initials: S
authors.lastname: Gowda
authors.affiliation: Division of Pulmonary & Critical Care and Sleep Medicine.
authors.forename: Pascal
authors.initials: P
authors.lastname: Kingah
authors.affiliation: Division of Pulmonary & Critical Care and Sleep Medicine asoubani@med.wayne.edu.
authors.forename: Ayman O
authors.initials: AO
authors.lastname: Soubani
mesh_terms: D004621:Embolization, Therapeutic / Q000295:instrumentation; D020065:Hepatopulmonary Syndrome / Q000150:complications / Q000628:therapy*; D006801:Humans; D000860:Hypoxia / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D011651:Pulmonary Artery
keywords: coil embolization; hepatopulmonary syndrome; hypoxemia; liver disease; liver transplantation; right-to-left shunt