THE CHEST RADIOGRAPH IN "JUVENILE" CIRRHOSIS (ACTIVE CHRONIC HEPATITIS)

Pulmonary hemorrhage in association with autoimmune chronic active hepatitis

Extrahepatic manifestations have been reported in a majority of patients with ACAH. We describe an 11-year-old girl with CAH who developed life-threatening AH and was successfully managed with mechanical ventilation and high-dose steroids. Although a number of pulmonary manifestations have been described in association with AICAH, this article is the first showing its association with AH.

Fibrosing alveolitis and hepatitis B surface antigen-associated chronic active hepatitis in a patient with immunoglobulin A deficiency

Fibrosing alveolitis is described in a 22 year old woman with immunoglobulin A (IgA) deficiency and hepatitis B surface antigen (HBsAg)-associated chronic active hepatitis. At lung biopsy HBsAg was detected by indirect immunofluorescence in the alveolar space but not in the septal fibrosis. We discuss the possible relationships between IgA deficiency on the one hand, and HBsAg-associated lung and liver diseases on the other hand.

Mottled chest radiograph and gas transfer defect in chronic liver disease

In a prospective study of 170 patients with various types of chronic liver disease, a pulmonary gas transfer defect was found in 20% and mottled shadowing in the chest radiograph in 6%. The presence of these abnormalities was not related to the cause of the liver disease.

Reduction of transfer factor in liver disease was not accompanied by a restrictive ventilatory defect and was found in most cases with mottled radiographs.

The incidence of finger clubbing and the levels of both venoarterial admixture and cardiac output were higher in patients with mottling than in those with normal radiographs. Mottling was also seen in the chest radiographs of five other patients with hepatic cirrhosis who had previously been investigated for cyanosis due to intrapulmonary shunting.

Despite earlier reports of active chronic hepatitis and primary biliary cirrhosis occurring in patients with fibrosing alveolitis, we suggest that these radiographic changes in liver disease are usually caused by a pulmonary vascular disorder, rather than by coincidental lung disease, and are a local manifestation of a generalized vasodilated state. The low incidence of diffuse lung disease complicating chronic liver disease was confirmed by reviewing the hospital necropsy records.

In one patient the radiographic mottling disappeared and the physiological evidence of a circulatory disorder became less marked during a period of improved hepatocellular function.