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Dyspnoea in a patient with hepatitis C
Jia-Feng Chang1,2,3, Cheng-Hsien Hsieh1, Jian-Chiun Liou4,5
1Department of Critical Care Medicine, En Chu Kong Hospital, New Taipei City, Taiwan.
A patient with chronic hepatitis C developed worsening shortness of breath due to hepatopulmonary syndrome. This condition causes abnormal lung blood vessels, leading to severe hypoxemia unresponsive to oxygen.
Area of Science:
- Cardiology
- Hepatology
- Pulmonology
Background:
- Chronic hepatitis C can lead to advanced liver disease.
- Hepatopulmonary syndrome (HPS) is a known complication of chronic liver disease.
Observation:
- A 60-year-old man with chronic hepatitis C presented with progressive dyspnea, cyanosis, and hypoxemia.
- Physical exam revealed digital clubbing, spider nevi, and shifting dullness.
- Imaging showed pleural effusions and prominent pulmonary vascular markings.
Findings:
- Contrast-enhanced echocardiography with agitated saline confirmed an intracardiac shunt.
- CT scan revealed vascular abnormalities consistent with HPS.
- The patient's hypoxemia was refractory to high-flow oxygen therapy.
Implications:
- Early diagnosis and management of HPS are crucial in patients with chronic liver disease.
- Identifying intracardiac shunts is key to understanding the pathophysiology of dyspnea in this context.
- This case highlights the importance of a multidisciplinary approach in managing complex hepatopulmonary complications.
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