Hepatopulmonary syndrome in portal hypertension.
Hepatopulmonary syndrome is an infrequent complication of portal hypertension
characterized by increased right-to-left shunting of blood due to intrapulmonary vascular dilatations resulting in varying degrees of hypoxemia.
Contrast enhanced echocardiography is the most sensitive way of demonstrating shunts while pulmonary perfusion scintigraphy can reveal the quantity of shunting.
This echocardiogram shows delayed appearance of the contrast material in the left cardiac chambers, and it is typical for intrapulmonary shunting (Fig.1). On pulmonary perfusion scintigraphy, marked uptake in brain and kidneys, which would not be visualised in the absence of shunting, revealed a shunt index of 25 % in this patient (Fig. 2 - Fig. 3).
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