Gastroenterology

Gastroenterology

Volume 109, Issue 4, October 1995, Pages 1283-1288
Gastroenterology

Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome,☆☆

https://doi.org/10.1016/0016-5085(95)90589-8Get rights and content

Abstract

Background & Aims: Two modalities, contrast echocardiography and lung perfusion scan, are used to identify intrapulmonary vascular dilatation and diagnose hepatopulmonary syndrome (HPS), but a comparison of these two procedures has not been performed. The aim of this study was to compare the use of these diagnostic modalities in detecting intrapulmonary vascular dilatation and diagnosing HPS. Methods: Forty consecutive outpatients with biopsy-proven cirrhosis had contrast echocardiography, a lung perfusion scan, and arterial blood gases analyzed. Results: Fifteen of 40 cirrhotics (38%) had positive contrast echocardiogram results. Seven patients with positive echocardiogram results had gas exchange abnormalities and could be considered to have HPS (7 of 40 [17.5%]). Three of these patients were hypoxemic and had no concurrent cardiopulmonary disease, and each had positive contrast echocardiogram and lung perfusion scan results and were readily diagnosed as having HPS. The other 4 patients (3 hypoxemic and 1 normoxemic with an elevated alveolar-arterial gradient) had coexisting intrinsic lung disease and/or chest radiograph abnormalities complicating the diagnosis of HPS, and each had positive echocardiogram and negative lung scan results. The remaining 8 patients with positive echocardiogram results had normal lung scan and normal gas exchange results. No patient had positive lung scan and negative contrast echocardiogram results. Conclusions: Contrast echocardiography is the most useful screening test for intrapulmonary vasodilatation and may be positive more frequently than lung perfusion scans in patients with HPS.

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    Supported in part by the General Clinical Research Center (RR-125) and the National Center for Research Resources. Dr. Abrams was a trainee of the Training Program in Clinical Investigation (DK 07476), supported by the National Institute of Diabetes and Digestive and Kidney Diseases.

    ☆☆

    Presented in part at the 1994 annual meeting of the American Association for the Study of Liver Diseases.

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