title: Prolonged Unexplained Hypoxemia as Initial Presentation of Cirrhosis: A Case Report.
abstract: BACKGROUND Hepatopulmonary syndrome (HPS) is a pulmonary complication of advanced liver disease with dyspnea as the predominant presenting symptom. The diagnosis of HPS can often be missed due to its nonspecific presentation and the presence of other comorbidities. CASE REPORT We present an interesting case of an obese 43-year-old man who presented with progressive, unexplained hypoxemia and shortness of breath in the absence of any symptoms or signs of chronic liver disease. After extensive cardiopulmonary investigations, he was diagnosed with severe HPS as a result of non-alcoholic steatohepatitis (NASH) leading to cirrhosis. He subsequently underwent successful hepatic transplantation and continues to improve at 12-month follow-up. CONCLUSIONS HPS needs to be considered in the differential diagnosis of unexplained hypoxemia. Given its poor prognosis, early diagnosis is warranted and treatment with liver transplantation is the preferred choice.
authors.affiliation: Department of Anaesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Anand
authors.initials: A
authors.lastname: Puttappa
authors.affiliation: Department of Anaesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Kumaraswamy
authors.initials: K
authors.lastname: Sheshadri
authors.affiliation: Department of Histopathology, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Aurelie
authors.initials: A
authors.lastname: Fabre
authors.affiliation: Department of Anaesthesia and Pain Medicine, Western Health, Melbourne, Australia.
authors.forename: Georgina
authors.initials: G
authors.lastname: Imberger
authors.affiliation: Department of Anaesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Boylan
authors.affiliation: Department of Respiratory and Sleep Medicine, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Silke
authors.initials: S
authors.lastname: Ryan
authors.affiliation: Department of Hepatology, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Masood
authors.initials: M
authors.lastname: Iqbal
authors.affiliation: Department of Anaesthesia and Intensive Care, St Vincent's University Hospital, Dublin, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: Conlon
mesh_terms: D000328:Adult; D015992:Body Mass Index; D003937:Diagnosis, Differential; D020065:Hepatopulmonary Syndrome / Q000150:complications* / Q000175:diagnosis* / Q000601:surgery; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D008103:Liver Cirrhosis / Q000175:diagnosis*; D016031:Liver Transplantation / Q000379:methods; D008297:Male; D009765:Obesity / Q000150:complications; D012307:Risk Factors; D016896:Treatment Outcome