• Device closure
• Patent foramen ovale
• Transesophageal echocardiography

• Echocardiography, Transesophageal/methods
• Follow-Up Studies
• Foramen Ovale/anatomy & histology
• Foramen Ovale/diagnostic imaging
• Foramen Ovale/surgery
• Foramen Ovale, Patent/diagnostic imaging
• Foramen Ovale, Patent/surgery
• Humans

• Echocardiography/instrumentation
• Echocardiography/methods
• Education, Medical, Graduate/methods
• Humans
• Point-of-Care Systems/standards
• Students, Medical
• Video Recording/standards

• Cirrhosis
• Hepatic hydrothorax
• Hepatocellular failure
• Hepatopulmonary syndrome
• Intrapulmonary shunting
• Portopulmonary hypertension

• Hepatopulmonary Syndrome/diagnosis
• Hepatopulmonary Syndrome/etiology
• Hepatopulmonary Syndrome/therapy
• Humans
• Hydrothorax/diagnosis
• Hydrothorax/etiology
• Hydrothorax/therapy
• Hypertension, Portal/complications
• Hypertension, Portal/diagnosis
• Hypertension, Portal/therapy
• Hypertension, Pulmonary/diagnosis
• Hypertension, Pulmonary/etiology
• Hypertension, Pulmonary/therapy
• Liver Cirrhosis/complications
• Liver Cirrhosis/diagnosis
• Liver Cirrhosis/therapy
• Liver Diseases/complications
• Liver Diseases/diagnosis
• Liver Diseases/therapy
• Liver Transplantation
• Lung Diseases/diagnosis
• Lung Diseases/etiology
• Lung Diseases/therapy

• Hepatopulmonary syndrome
• Liver transplantation
• Pulmonary complications of cirrhosis

This report presents the case of a 42-year-old man with liver cirrhosis who presents with breathlessness. Initial investigations are unable to explain his persistent hypoxia and a diagnosis of hepatopulmonary syndrome is considered. Saline contrast echocardiography is utilised in confirming the diagnosis. Details of this case as well as practicalities in performing and interpreting saline contrast echocardiography are reviewed.

Hepatopulmonary syndrome is a rare disease that affects patients of any age with acute or chronic liver disease. Liver transplantation is the only therapeutic option of proved benefit, and can result in substantial improvement or total improvement in postoperative gas exchange abnormalities.

We report the case of a cyanotic 13-year-old Pakistani boy whose chest computed tomography scan showed normal lung fields and mediastinum with incidental findings of a prominent liver surface with a collateral vein connecting a portal cavernoma to the dilated terminal inferior vena cava. Sonography of his abdomen along with a portal venous Doppler study showed multiple collateral veins replacing the portal vein. A liver biopsy revealed congenital hepatic fibrosis. Contrast-enhanced echocardiography with agitated saline and a 99m Technetium-macroaggregated albumin perfusion lung scan confirmed intrapulmonary shunting. The patient underwent a successful liver transplantation that resulted in improved gas exchange.

Hepatopulmonary syndrome should be included in the differential diagnosis of unexplained hypoxemia with an evaluation of possible portal hypertension or liver disease even in the absence of other clinical symptoms.

• American Heart Association
• Cause of Death
• Coronary Disease/diagnosis
• Coronary Disease/mortality
• Coronary Disease/prevention & control
• Death, Sudden, Cardiac/prevention & control
• Foundations
• Humans
• Kidney Transplantation
• Liver Transplantation
• Mass Screening
• Middle Aged
• Postoperative Complications/mortality
• Postoperative Complications/prevention & control
• Risk Assessment
• United States

• K08DK073036 NIDDK NIH HHS

• Disease Management
• Heart Diseases/diagnosis
• Heart Diseases/epidemiology
• Heart Diseases/therapy
• Humans
• Kidney Transplantation/mortality
• Liver Transplantation/mortality
• Patient Selection
• Perioperative Period
• Risk Factors

• K08DK073036 NIDDK NIH HHS