Karlish A J, Marshall R, Reid L, Sherlock S
Thorax. 1967 Nov;22(6):555-61. doi: 10.1136/thx.22.6.555.
A case is reported of cirrhosis of the liver associated with cyanosis and finger clubbing in a man of 31 years. The chest radiograph showed diffuse nodular shadows in both lower zones. Pulmonary function tests gave an arterial oxygen saturation of 91% at rest, falling to 68% on exercise; the single breath diffusing capacity for carbon monoxide was reduced to 55% of the predicted value and there was an estimated right-to-left shunt of 23%. Post-mortem injection of the lungs with Micropaque-gelatin suspension showed numerous pleural spider naevi, denser over the lower lobes, arteriovenous communications in the infrahilar regions, including leashes of dilated vessels in pleural adhesions on the diaphragm and diffuse arterial vasodilatation in the lungs; although the injection mass could be traced into the pulmonary veins in only a few regions of the lung, the dilated arterioles and spiders were possible additional channels through which blood might be shunted from the alveolar surfaces. The very low arterial oxygen saturation on exercise was probably caused by a shunt greater than the 23% estimated at rest, but the low diffusing capacity may have been partly responsible. The cause of the low diffusing capacity remains uncertain.
报告一例31岁男性肝硬化合并发绀和杵状指的病例。胸部X线片显示两下肺野弥漫性结节状阴影。肺功能检查结果显示，静息时动脉血氧饱和度为91%，运动时降至68%；单次呼吸一氧化碳弥散量降至预测值的55%，估计有23%的右向左分流。尸检时向肺内注入微显影剂-明胶混悬液，可见大量胸膜蜘蛛痣，下叶更为密集，肺门下部区域存在动静脉交通，包括膈肌胸膜粘连处扩张血管束以及肺内弥漫性动脉血管扩张；尽管仅在肺的少数区域可追踪到注入物进入肺静脉，但扩张的小动脉和蜘蛛痣可能是血液从肺泡表面分流的额外通道。运动时极低的动脉血氧饱和度可能是由于分流大于静息时估计的23%，但低弥散量可能也起了部分作用。低弥散量的原因尚不确定。
