Hypoxemia in a Patient With End-Stage Liver Disease

Hepatopulmonary syndrome, an unusual cause of hypoxemia

A six-year-old boy presented with cough, cyanosis and clubbing. Investigations revealed hypoxia (PaO2 53 mm Hg on room air) which was only partially correctable (PaO2 73 mm Hg) with 100% oxygen administered through a non re breathing face mask. Liver function tests showed elevated total bilirubin, and transaminases, liver biopsy confirmed chronic hepatitis and endoscopy showed grade three varices. A contrast enhanced echocardiography (bubble study) revealed pulmonary arterio-venous communication. A diagnosis of hepatopulmonary syndrome was made based on the triad of hypoxemia, liver disease and intra pulmonary vascular communications.

[Thoracic manifestations of gastrointestinal diseases]

Variety of gastrointestinal tract (GIT) changes that have their manifestation in thorax, disable their detailed review. Therefore, this article, represents short and overall over-view of these conditions. Standard chest x-ray can reveal esophageal disorders, herniation of abdominal organs into thorax, signs of GIT organs perforation, subphrenic abscess. Numerous diseases of intrabadominal organs of digestive tract can spread to the thorax, either per continuitatem or by lymphogenous or hemaotgenous dissemination. Therefore, chest x-ray is obliged by investigation of abdominal organs. If it is necessary additional diagnostic procedures are performed to confirm or exclude the association of lung or pleura features with GIT disorders. Above mentioned, just confirm that chest x-ray is first in algorithm of diagnostic procedures in these pathologic conditions. If there is any suspicion to conditions that require patients treatment, additional imaging methods like computerized tomography (CT), ultrasonography (US) and barium enema of digestive tract are necessary.