Pulmonary hypertension in hepatitis B virus carriers

Two autopsy cases of pulmonary hypertension (PH) associated with liver cirrhosis are presented. Both patients were hepatitis B (HB) virus carriers and suffered from type B cirrhosis during the clinical course. The first patient was a 52-year-old male with type B cirrhosis. He died of hepatic encephalopathy but did not have any specific symptoms for PH except abnormal laboratory findings. Chest roentgenograms displayed prominence of the central pulmonary artery. Cardiac catheterization indicated marked increment of pulmonary arterial pressure. Autopsy revealed dilatation and sclerosis of the main pulmonary artery and right ventricular hypertrophy. Microscopically, the pulmonary arteries showed intimal fibrosis, medial hypertrophy, and plexiform lesions throughout the lungs. The second patient, a 15-year-old boy, had PH with juvenile liver cirrhosis which had existed for 8 years prior to the onset of PH. He complained of severe dyspnea and dizziness before death. Electrocardiogram indicated right ventricular hypertrophy. Autopsy disclosed cardiomegaly, type B cirrhosis and sclerotic pulmonary arteries. Grade VI pulmonary plexogenic arteriopathy including plexiform lesions and necrotizing arteritis was observed. HBsAg was detected in both the hepatocytes and the pulmonary arterial walls. We discuss the possible relationship between persistent HB viral infection and PH with liver cirrhosis.