TY - JOUR
T1 - The hepatopulmonary syndrome
T2 - Radiologic findings in 10 patients
AU - McAdams, H. Page
AU - Erasmus, Jeremy
AU - Crockett, Robert
AU - Mitchell, John
AU - Godwin, J. David
AU - McDermott, Vincent G.
PY - 1996/6
Y1 - 1996/6
N2 - OBJECTIVE. The purpose of this study was to review the radiologic manifestations of the hepatopulmonary syndrome. MATERIALS AND METHODS. We retrospectively reviewed clinical records, chest radiographs, 99mTc- macroaggregated albumin (MAA) perfusion lung scans, chest CT scans, and pulmonary angiograms of 10 patients with proven hepatopulmonary syndrome. RESULTS. Chest radiographs showed basilar, medium-sized (1.5-3.0 mm) nodular or reticulonodular opacities in all cases. CT was done in eight cases and showed basilar dilatation of lung vessels with a larger than normal number of visible branches. The vascular basis for these opacities was best appreciated on conventional CT scans of 10-mm sections. No individual arteriovenous malformations were seen on CT scans. High-resolution CT scans showed no evidence of interstitial fibrosis. 99mTc-MAA perfusion lung imaging, done in seven patients, showed pulmonary arteriovenous shunting in five. Contrast echocardiography confirmed Intrapulmonary shunting in these five patients. Pulmonary angiography, done in four cases, showed subtle distal vascular dilatation in two and moderate dilatation with early venous filling in two but did not reveal any individual arteriovenous malformations. CONCLUSION. Chest radiographs in hepatopulmonary syndrome usually show bibasilar nodular or reticulonodular opacities. Conventional CT shows that these opacities represent dilated lung vessels. High-resolution CT is useful in excluding pulmonary fibrosis or emphysema as the cause of these opacities. 99mTc- MAA perfusion imaging or contrast echocardiography can be used to confirm intrapulmonary arteriovenous shunting.
AB - OBJECTIVE. The purpose of this study was to review the radiologic manifestations of the hepatopulmonary syndrome. MATERIALS AND METHODS. We retrospectively reviewed clinical records, chest radiographs, 99mTc- macroaggregated albumin (MAA) perfusion lung scans, chest CT scans, and pulmonary angiograms of 10 patients with proven hepatopulmonary syndrome. RESULTS. Chest radiographs showed basilar, medium-sized (1.5-3.0 mm) nodular or reticulonodular opacities in all cases. CT was done in eight cases and showed basilar dilatation of lung vessels with a larger than normal number of visible branches. The vascular basis for these opacities was best appreciated on conventional CT scans of 10-mm sections. No individual arteriovenous malformations were seen on CT scans. High-resolution CT scans showed no evidence of interstitial fibrosis. 99mTc-MAA perfusion lung imaging, done in seven patients, showed pulmonary arteriovenous shunting in five. Contrast echocardiography confirmed Intrapulmonary shunting in these five patients. Pulmonary angiography, done in four cases, showed subtle distal vascular dilatation in two and moderate dilatation with early venous filling in two but did not reveal any individual arteriovenous malformations. CONCLUSION. Chest radiographs in hepatopulmonary syndrome usually show bibasilar nodular or reticulonodular opacities. Conventional CT shows that these opacities represent dilated lung vessels. High-resolution CT is useful in excluding pulmonary fibrosis or emphysema as the cause of these opacities. 99mTc- MAA perfusion imaging or contrast echocardiography can be used to confirm intrapulmonary arteriovenous shunting.
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U2 - 10.2214/ajr.166.6.8633451
DO - 10.2214/ajr.166.6.8633451
M3 - Article
C2 - 8633451
AN - SCOPUS:0029898905
SN - 0361-803X
VL - 166
SP - 1379
EP - 1385
JO - American Journal of Roentgenology
JF - American Journal of Roentgenology
IS - 6
ER -