• Cirrhosis
• Portal Hypertension
• Transjugular Intrahepatic Portosystemic Shunt

• Humans
• Female
• Male
• Portasystemic Shunt, Transjugular Intrahepatic/adverse effects
• Middle Aged
• Hepatopulmonary Syndrome/epidemiology
• Hepatopulmonary Syndrome/surgery
• Prevalence
• Aged
• Adult
• Retrospective Studies
• Dilatation, Pathologic
• Echocardiography
• Clinical Relevance

• Deep learning
• Disease classification
• Heart shunts
• Saline contrast transthoracic echocardiography

• Humans
• Neural Networks, Computer
• Echocardiography/methods
• Male
• Female
• Middle Aged
• Microbubbles
• Adult
• Contrast Media
• Image Interpretation, Computer-Assisted/methods

• 2022NSFSC0833 Natural Science Foundation of Sichuan Province
• 2022NSFSC0605 Natural Science Foundation of Sichuan Province
• SXHZ019 Bureau of Science and Technology Nanchong City
• 2023YFQ0006 Sichuan Provincial Science and Technology Plan

• bleeding
• cardiac testing
• portal hypertension
• risk
• varices

• Echocardiography, Transesophageal/adverse effects
• Esophageal and Gastric Varices/diagnostic imaging
• Esophageal and Gastric Varices/epidemiology
• Esophageal and Gastric Varices/etiology
• Gastrointestinal Hemorrhage/diagnostic imaging
• Gastrointestinal Hemorrhage/epidemiology
• Gastrointestinal Hemorrhage/etiology
• Humans
• Incidence
• Liver Cirrhosis/complications
• Varicose Veins/complications

• R01 CA256977 NCI NIH HHS

• Diagnostic tests
• Intrapulmonary vascular dilations
• Portal hypertension
• Radionuclide imaging
• Sensitivity and specificity
• Technetium-99m-labeled macroaggregated albumin lung perfusion scan

• Adult
• Blood Gas Analysis
• Brain/blood supply
• Brain/metabolism
• Dilatation, Pathologic/diagnosis
• Female
• Hepatopulmonary Syndrome/diagnosis
• Hepatopulmonary Syndrome/etiology
• Humans
• Hypertension, Pulmonary/complications
• Liver Diseases/complications
• Lung/blood supply
• Lung/metabolism
• Male
• Middle Aged
• Oxygen/blood
• Perfusion Imaging/methods
• Prospective Studies
• Radionuclide Imaging/methods
• Radiopharmaceuticals/pharmacokinetics
• Technetium Tc 99m Aggregated Albumin/pharmacokinetics
• Vascular Diseases/diagnosis
• Vascular Diseases/etiology

Hepatopulmonary syndrome (HPS), found in cirrhotic patients, has been little studied in hepatosplenic schistosomiasis (HSS) and includes the occurrence of intrapulmonary vascular dilatations (IPVD). Contrast transesophageal echocardiography (cTEE) with microbubbles is more sensitive than contrast transthoracic echocardiography (cTTE) with microbubbles in the detection of IPVD in cirrhosis.

To assess the performance of the cTEE, compared with that of cTTE, in detecting IPVD for the diagnosis of HPS in patients with HSS.

cTEE and cTTE for investigation of IPVD and laboratory tests were performed in 22 patients with HSS. Agitated saline solution was injected in peripheral vein during the cTEE and cTTE procedures. Late appearance of the microbubbles in the left chambers indicated the presence of IPVD. Results of the two methods were compared by the Student’s t-test and the chi-square test (p < 0.05).

cTEE was performed in all patients without complications. Three patients were excluded due to the presence of patent foramen ovale (PFO). The presence of IPVD was confirmed in 13 (68%) of 19 patients according to the cTEE and in only six (32%, p < 0.01) according to the cTTE. No significant differences in clinical or laboratory data were found between the groups with and without IPVD, including the alveolar-arterial gradient. The diagnosis of HPS (presence of IPVD with changes in the arterial blood gas analysis) was made in five patients by the cTEE and in only one by the cTTE (p = 0.09).

In HSS patients, cTEE was safe and superior to cTTE in detecting IPVD and allowed the exclusion of PFO.

• digital subtraction angiography
• hepatopulmonary syndrome
• intrapulmonary vascular dilations
• portal hypertension
• pulmonary transit time

• Adult
• Aged
• Angiography
• Dilatation, Pathologic
• Echocardiography
• Female
• Hepatopulmonary Syndrome/diagnostic imaging
• Hepatopulmonary Syndrome/pathology
• Humans
• Hypertension, Portal/complications
• Liver Diseases/complications
• Lung/blood supply
• Male
• Middle Aged
• Prospective Studies
• Pulmonary Circulation
• ROC Curve

• QT interval
• children
• cirrhotic cardiomyopathy
• liver transplantation

Hepatopulmonary syndrome (HPS) is defined as an oxygenation defect induced by intrapulmonary vasodilation in patients with liver disease or portal hypertension. It is investigated in patients with liver cirrhosis and less frequently in those with portal hypertension without liver cirrhosis, as may occur in hepatosplenic schistosomiasis (HSS).

To investigate the prevalence of HPS in patients with HSS, and to determine whether the occurrence of HPS is influenced by concomitant cirrhosis.

We evaluated patients with HSS with or without concomitant liver cirrhosis. All patients underwent laboratory testing, ultrasound, endoscopy, contrast echocardiography, and arterial blood gas analysis.

Of the 121 patients with HSS, 64 were also diagnosed with liver cirrhosis. HPS was diagnosed in 42 patients (35%) and was more frequent among patients with concomitant liver cirrhosis than in those without cirrhosis (42% vs. 26%), but the difference was not significant (p = 0.069). HPS was more common in those with spider naevi, Child-Pugh classes B or C and high model for end stage liver disease (MELD) scores (p < 0.05 each).

The prevalence of HPS was 35% in this study. The occurrence of liver cirrhosis concomitantly with HSS may have influenced the frequency of patients presenting with HPS.

Schistosomiasis is endemic to several parts of the world. Among the species that affect humans, Schistosoma mansoni is one of the most common causes of illness. In regions where schistosomiasis mansoni is endemic, reinfection is responsible for the emergence of hepatosplenic schistosomiasis (HSS) with portal hypertension in about 10% of infected individuals. Regardless of its etiology, portal hypertension may bring about the formation of arteriovenous fistulas and pulmonary vascular dilation, thus constituting a pulmonary shunt and its presence has been associated with the occurrence of neurological complications. The objective of this study was to identify pulmonary shunt using TTCE in patients with HSS and esophageal varices, and to compare the abdominal ultrasound and endoscopy findings among patients with and without pulmonary shunt.

In this case series, a total of 461 patients with schistosomiasis mansoni were prospectively evaluated using abdominal ultrasound and endoscopy and 71 presented with HSS with esophageal varices. Fifty seven patients remained in the final analysis. The mean age of the patients was 55 ± 14 years, and 65% were female. Pulmonary shunts were observed in 19 (33.3%) patients. On comparing the groups with and without pulmonary shunt, no significant differences were observed in relation to the abdominal ultrasound and endoscopic findings. When comparing the two subgroups with pulmonary shunts (grade 1 vs grades 2 and 3), it was observed that the subgroup with shunt grades 2 and 3 presented with a significantly higher frequency of an enlarged splenic vein diameter (>0.9 cm), and an advanced pattern of periportal hepatic fibrosis (P = 0.041 and P = 0.005, respectively). None of the patients with pulmonary shunts had severe neurological complications.

Our findings suggest that in HSS with esophageal varices the pulmonary shunts may be present in higher grades and that in this condition it was associated with ultrasound findings compatible with advanced HSS.

Among the species of Schistosoma that infect humans Schistosoma mansoni is one of the most common causes of illness. In the areas where schistosomiasis mansoni is endemic, around 10% of infected individuals develop hepatosplenic schistosomiasis (HSS) with portal hypertension. Portal hypertension may promotes an imbalance in the hepatic production of vasoactive substances, which may act on the lungs promoting the formation of arteriovenous fistulas and pulmonary vascular dilation, a condition that is called a pulmonary shunt. When the pulmonary shunt is of higher grades, small thrombus or septic emboli that would normally be filtered through the pulmonary capillaries reach the left heart and the systemic circulation, which can lead to neurological complications. We found pulmonary shunts in patients with HSS and esophageal varices and we also found that patients with higher grades of pulmonary shunts presented with a significantly higher frequency of advanced periportal fibrosis and an enlarged splenic vein diameter. No neurological complications were observed. Our findings suggest that pulmonary shunts may be present in patients with HSS and esophageal varices. The abdominal ultrasound findings compatible with advanced HSS could be used as screening to investigate pulmonary shunt.

• Abdomen/diagnostic imaging
• Adult
• Aged
• Animals
• Echocardiography/methods
• Esophageal and Gastric Varices/complications
• Esophageal and Gastric Varices/diagnostic imaging
• Esophageal and Gastric Varices/parasitology
• Esophageal and Gastric Varices/physiopathology
• Female
• Humans
• Hypertension, Portal/complications
• Hypertension, Portal/diagnostic imaging
• Hypertension, Portal/parasitology
• Hypertension, Portal/physiopathology
• Liver Diseases, Parasitic/complications
• Liver Diseases, Parasitic/diagnostic imaging
• Liver Diseases, Parasitic/parasitology
• Liver Diseases, Parasitic/physiopathology
• Male
• Middle Aged
• Prospective Studies
• Schistosoma mansoni/isolation & purification
• Schistosomiasis mansoni/complications
• Schistosomiasis mansoni/diagnostic imaging
• Schistosomiasis mansoni/physiopathology
• Splenic Diseases/complications
• Splenic Diseases/diagnostic imaging
• Splenic Diseases/parasitology
• Splenic Diseases/physiopathology
• Ultrasonography

Hepatopulmonary syndrome (HPS) is a respiratory complication of hepatic disease, that is well recognized in humans and defined by the presence of 1) liver disease, 2) hypoxemia and/or high alveolar-arterial oxygen gradient (AaDO₂) and 3) intrapulmonary vasodilatation. The present report describes a similar case of HPS in a dog. A six-month-old Papillon was diagnosed with ductal plate malformation with chronic active hepatitis and showed progressive increases in AaDO₂ over the course of the following six months. The presence of intrapulmonary vasodilatation was confirmed by agitated saline contrast transthoracic echocardiography. Also, the absence of congenital cardiac defect was confirmed by transthoracic echocardiography. From these results, we suspected that this dog had HPS. This is the first description of suspected canine HPS.

Patient: Male, 45

Final Diagnosis: Hepatopulmonary syndrome

Symptoms: Dyspnea • edema of feet

Medication: —

Clinical Procedure: None

Specialty: Gastroenterology and Hepatology

Arterial blood gas analysis is an important diagnostic and monitoring tool for respiratory abnormalities. In human medicine, lung complications often occur as a result of liver disease. Although pulmonary complications of liver disease have not been reported in dogs, we have frequently encountered hypoxemia in dogs with liver disorders, especially extrahepatic biliary obstruction. In addition, respiratory disorders account for 20% of perioperative fatalities in dogs. Therefore, in this study, we evaluated the respiratory status in dogs with hepatobiliary disease by arterial blood gas analysis. PaO₂ and PaCO₂ were measured. Alveolar-arterial oxygen difference (AaDO₂), the indicator of gas exchange efficiency, was calculated. Compared to healthy dogs (control group), hepatobiliary disease dogs had significantly lower PaO₂ and higher AaDO₂. Hypoxemia (PaO₂ of ≤80 mmHg) was observed in 28/71 dogs with hepatobiliary disease. AaDO₂ was higher (≥30 mmHg) than the control group range (11.6 to 26.4 mmHg) in 32/71 hepatobiliary disease dogs. By classifying type of hepatobiliary disease, dogs with extrahepatic biliary obstruction and chronic hepatitis showed significantly lower PaO₂ and higher AaDO₂ than in a control group. Dogs with chronic hepatitis also had significantly lower PaCO₂. The present study shows that dogs with hepatobiliary disease have respiratory abnormalities more than healthy dogs. Preanesthetic or routine arterial blood gas analysis is likely beneficial to detect the respiratory abnormalities in dogs with hepatobiliary disease, especially extrahepatic biliary obstruction and chronic hepatitis.

• Cirrhosis
• Cirrosis
• Contrast-enhanced echocardiography
• Contrast-enhanced transcranial Doppler
• Diagnostic validity studies
• Dilataciones vasculares pulmonares
• Doppler transcraneal con contraste
• Ecocardiografía con contraste
• Estudios de validez diagnóstica
• Hepatopulmonary syndrome
• Liver transplantation
• Pulmonary vascular dilatations
• Síndrome hepatopulmonar
• Trasplante hepático

Transpulmonary bubble transit (TPBT) detected with contrast echocardiography is reported as a sign of intrapulmonary shunt during cirrhosis or exercise in healthy humans. However, its physiological meaning is not clear during acute respiratory distress syndrome (ARDS). Our aim was to determine the prevalence, significance, and prognosis of TPBT detection during ARDS.

This was a prospective observational study in an academic medical intensive care unit in France. Two hundred and sixteen consecutive patients with moderate-to-severe ARDS underwent transesophageal echocardiography with modified gelatine contrast. Moderate-to-large TPBT was defined as right-to-left passage of at least ten bubbles through a pulmonary vein more than three cardiac cycles after complete opacification of the right atrium. Patients with intra-cardiac shunt through patent foramen ovale were excluded.

The prevalence of moderate-to-large TPBT was 26% (including 42 patients with moderate and 15 with large TPBT). Patients with moderate-to-large TPBT had higher values of cardiac index and heart rate as compared to those without TPBT. There was no significant difference in PaO₂/FIO₂ ratio between groups, and TPBT was not influenced by end-expiratory positive pressure level in 93% of tested patients. Prevalence of septic shock was higher in the group with moderate-to-large TPBT. Patients with moderate-to-large TPBT had fewer ventilator-free days and intensive care unit-free days within the first 28 days, and higher in-hospital mortality as compared to others.

Moderate-to-large TPBT was detected with contrast echocardiography in 26% of patients with ARDS. This finding was associated with a hyperdynamic and septic state, but did not influence oxygenation.

• Acute respiratory distress syndrome
• Echocardiography
• Shunt

• Contrast echocardiography
• Hepatopulmonary syndrome
• Hypoxemia
• Intrapulmonary vasodilatation
• Liver transplantation
• Portal hypertension

• Chronic Disease
• Disease Management
• Diuretics/therapeutic use
• Hepatopulmonary Syndrome/etiology
• Humans
• Hydrothorax/etiology
• Hypertension, Portal/complications
• Hypertension, Pulmonary/etiology
• Liver Cirrhosis/complications
• Liver Cirrhosis/therapy
• Liver Diseases/complications
• Liver Diseases/therapy
• Liver Transplantation
• Portasystemic Shunt, Transjugular Intrahepatic

• R01 DK056804 NIDDK NIH HHS

• intra-pulmonary shunt
• patent foramen ovale
• three-dimensional echocardiography
• transesophageal echocardiography

• portal hypertension
• bleeding
• oesophageal varices
• audit
• gastrointestinal haemorrhage

• Animals
• Disease Models, Animal
• Hepatopulmonary Syndrome/etiology
• Hepatopulmonary Syndrome/physiopathology
• Humans
• Liver Cirrhosis, Biliary/physiopathology
• Lung/blood supply
• Lung/physiopathology
• Microvessels/physiopathology
• Neovascularization, Pathologic/physiopathology
• Pulmonary Gas Exchange/physiology
• Rats
• Vasodilation/physiology

• R01 DK056804 NIDDK NIH HHS
• 5DKR01DK056804 PHS HHS

• 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

• Hepatopulmonary syndrome
• liver transplant
• respiratory disorders

To review the pathogenesis of pulmonary vascular complications of liver disease, we discuss their clinical implications, and therapeutic considerations, with emphasis on potential reversibility of the hepatopulmonary syndrome after liver transplantation. In this review, we also discuss the role of imaging in pulmonary vascular complications associated with liver disease.

• Hepatopulmonary syndrome
• Yttrium-90 microsphere embolization hepatocellular carcinoma
• portopulmonary hypertension
• pulmonary arteriovenous shunts

• Adult
• Hepatopulmonary Syndrome/diagnosis
• Hepatopulmonary Syndrome/etiology
• Hepatopulmonary Syndrome/therapy
• Humans
• Liver Transplantation
• Waiting Lists

• Contrast Media
• Diagnosis, Differential
• Echocardiography/methods
• Female
• Hepatopulmonary Syndrome/diagnostic imaging
• Hepatopulmonary Syndrome/surgery
• Humans
• Liver Cirrhosis/diagnostic imaging
• Liver Transplantation/diagnostic imaging
• Male
• Middle Aged
• Patient Selection
• Preoperative Care
• Prognosis
• Reproducibility of Results
• Sensitivity and Specificity
• Sodium Chloride

• Accreditation/standards
• Critical Care/standards
• Echocardiography/standards
• Education, Continuing/standards
• Europe
• Internationality
• Practice Guidelines as Topic
• Practice Patterns, Physicians'/trends

• hepatopulmonary syndrome
• liver cirrhosis
• lung diseases

• Cardiovascular Agents/therapeutic use
• Disease Progression
• Hepatopulmonary Syndrome/diagnosis
• Hepatopulmonary Syndrome/physiopathology
• Hepatopulmonary Syndrome/therapy
• Humans
• Hypoxia/diagnosis
• Hypoxia/physiopathology
• Hypoxia/therapy
• Liver Transplantation
• Portasystemic Shunt, Transjugular Intrahepatic
• Pulmonary Artery/physiopathology
• Radiography, Interventional
• Treatment Outcome
• Vasodilation