Patent Foramen Ovale Closure in Neuroendocrine Prostate Cancer-Induced Hepatopulmonary Syndrome: Fruitful or Futile?

Hepatopulmonary syndrome (HPS) is a cause of hypoxemia secondary to advanced liver disease. Neuroendocrine prostate cancer (NEPC) is a rare but highly aggressive cancer with poor prognosis.

This is a unique case of hypoxemia from HPS induced by NEPC, exacerbated by right-to-left shunting from a previously insignificant patent foramen ovale (PFO). PFO closure yielded brief resolution of symptoms, but without early confirmation of NEPC diagnosis, the patient ultimately died.

There are few cases in the literature that discuss HPS secondary to malignancy and none to date about NEPC causing HPS. This case highlights the importance of early identification of NEPC, clinical diagnosis strategy, and discussion of intervention of PFO closure in cases of HPS.