Unusual dyspnoea in a patient with liver cirrhosis

A 66-year-old woman with hepatitis C related liver cirrhosis presented to our hospital for dyspnoea and cyanosis. Tachypnoea, low grade fever, clubbed fingers, palmar erythaema, spider angioma, wheezing and severe hypoxaemia were found. Chronic obstructive pulmonary disease (COPD) with acute exacerbation was diagnosed and she recovered after bronchodilator and antibiotic treatment. However, dyspnoea and hypoxaemia recurred with widened alveolar-arterial gradient, which was unusual in COPD. A pulmonary function test showed moderate obstructive ventilatory defect and chest high resolution CT scan disclosed some dilated vessels over the left lower lung. Interestingly, platypnoea and orthodeoxia were observed, therefore hepatopulmonary syndrome was suspected and was confirmed by contrast echocardiography, lung perfusion scan and 100% oxygen administration. Her dyspnoea improved gradually after oxygen use. She was followed in our clinic for 3 years and her respiratory condition on home oxygen remained stable, as did the liver cirrhosis.