[Technics for the exploration of pulmonary arteriovenous shunts in liver cirrhosis. Apropos of 2 cases].

Pulmonary arterio-venous shunts represent a rare cause of hypoxia in cirrhosis. We present two cases, the first was an alcoholic cirrhotic with anthracosilicosis. This patient rapidly developed a picture of significant hypoxaemia with a raised alveolar-arterial oxygen gradient. The presence of this shunt was confirmed by a scintigraphic analysis. A porto-pulmonary localisation was excluded by a changing angiographic picture. Death supervened after refractory hypoxaemia. Post mortem microangiographic studies confirmed the pulmonary nature of the shunt and its pre-capillary localisation. The second patient was alcoholic, with a compensated cirrhosis and developed severe hypoxaemia which progressed to death in less than two months, when he was being treated effectively with corticosteroids for a diffuse interstitial pulmonary fibrosis confirmed histologically. The pulmonary localisation of the shunt was confirmed by an analysis of the angioscintigraphs. The different techniques for the investigation of intra-pulmonary shunt are discussed, as well as the patho-physiological mechanisms involved. The hormone levels measured (sex hormones, serotonin, prostaglandins, intestinal hormones) remained normal. The therapeutic trials tried out (oestrogen, CPD Choline, indomethacin) were ineffective.