Phillips Caroline, Harris Clare, Broughton Nathaniel, Pulimood Thomas, Ring Liam
Department of Anaesthesia and Critical Care, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK.
Department of Respiratory Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK.
Case Rep Crit Care. 2018 Apr 17;2018:3417259. doi: 10.1155/2018/3417259. eCollection 2018.
We present the case of a 68-year-old gentleman who presented with breathlessness and was found to have NSTEMI, pulmonary oedema, and hypoxia. He remained hypoxic despite appropriate treatment and was found to have preserved LV function and raised cardiac output. CT pulmonary angiogram was negative but a cirrhotic liver was incidentally noted and later confirmed via ultrasound. Bedside examination was positive for orthodeoxia, suggesting a diagnosis of hepatopulmonary syndrome (HPS). The finding of significant intrapulmonary shunting on "bubble" echocardiography confirmed the diagnosis. This patient did not have previously diagnosed liver disease and had largely normal LFTs when the diagnosis was first suspected. We discuss HPS in the context of ICU and suggest how it may be screened for using simple tests. There is no correlation between the presence of HPS and severity of liver disease, yet we believe this is the first reported adult case of HPS on the ICU without previously diagnosed cirrhosis.
我们报告一例68岁男性患者，其因呼吸困难就诊，被诊断为非ST段抬高型心肌梗死、肺水肿和低氧血症。尽管接受了适当治疗，他仍持续低氧，检查发现其左心室功能正常但心输出量增加。CT肺动脉造影结果为阴性，但偶然发现肝脏呈肝硬化表现，随后经超声检查得以证实。床边检查立位低氧试验呈阳性，提示诊断为肝肺综合征（HPS）。“气泡”超声心动图显示存在显著肺内分流，进一步证实了该诊断。该患者既往无肝脏疾病诊断史，在首次怀疑诊断时肝功能检查结果基本正常。我们在重症监护病房（ICU）的背景下讨论了HPS，并提出了如何通过简单检查进行筛查的建议。HPS的存在与肝脏疾病的严重程度之间没有相关性，但我们认为这是首例在ICU中报道的既往无肝硬化诊断的成人HPS病例。
