title: An unusual cause of refractory hypoxemia in cirrhosis.
abstract: Pulmonary gas exchange abnormalities and refractory hypoxemia cause myriad difficulties in patients with chronic liver disease. In addition to intrinsic cardiopulmonary diseases and hepatopulmonary syndrome, some unusual pathophysiological mechanisms in patients with portosystemic collaterals might contribute to hypoxemia. We report the clinical presentation of an unusual portosystemic anatomic shunt that permits venous admixture with oxygenated blood, causing hypoxemia that is refractory to the administration of supplemental oxygen, and recurrent hepatic encephalopathy. There has been no such report in the published literature. This case highlights the importance of keeping direct portopulmonary venous anastomosis in the differential diagnosis of oxygen-refractory hypoxemia and recurrent hepatic encephalopathy in patients with cirrhosis in the appropriate clinical context.
authors.affiliation: Department of Radiodiagnosis.
authors.forename: Yashwant
authors.initials: Y
authors.lastname: Patidar
authors.affiliation: Department of Pulmonary Medicine, Institute of Liver and Biliary Sciences, New Delhi, India. sachin.drk@gmail.com drsachin.kumar@ilbs.in.
authors.forename: Sachin
authors.initials: S
authors.lastname: Kumar
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D008103:Liver Cirrhosis / Q000150:complications*; D008297:Male; D011652:Pulmonary Circulation / Q000502:physiology*; D011659:Pulmonary Gas Exchange
keywords: cirrhosis; contrast echocardiography; hepatic encephalopathy; hypertension; hypoxemia; portal; portosystemic shunt