Hansoti R C, Sharma S
Department of Cardiology, T.N. Medical College, Bombay, India.
Chest. 1989 Oct;96(4):843-8. doi: 10.1378/chest.96.4.843.
During the last 25 years, 20 patients with cirrhosis of liver with severe cyanosis and gross clubbing simulating congenital cyanotic heart disease were subjected to cardiac catheterization and angiography, splenography, liver function tests, and liver biopsy. No portopulmonary fistulas could be demonstrated. The cyanosis and clubbing were secondary to right to left intrapulmonary shunting across multiple tiny pulmonary arteriovenous fistulas. In 15 cases, selective pulmonary angiography revealed discrete arteriovenous fistulas. In five cases, the angiogram did not reveal any convincing evidence of pulmonary arteriovenous fistulas. In two of these five cases, peripheral vein contrast echocardiography demonstrated right to left intrapulmonary shunting and seems a sensitive investigation. Open lung biopsy in one case showed evidence of pulmonary arteriovenous fistulas.
在过去25年中，对20例患有肝硬化且伴有严重发绀和明显杵状指、类似先天性青紫型心脏病的患者进行了心导管检查、血管造影、脾造影、肝功能测试和肝活检。未发现存在肺动静脉瘘。发绀和杵状指是由于多个微小肺动静脉瘘导致的右向左肺内分流所致。15例患者经选择性肺血管造影显示有离散的动静脉瘘。5例患者血管造影未显示任何令人信服的肺动静脉瘘证据。在这5例患者中的2例，经外周静脉对比超声心动图显示有右向左肺内分流，这似乎是一项敏感的检查。1例患者经开放性肺活检显示有肺动静脉瘘的证据。
