Hepatopulmoner sendrom tanısında kalın kesit reformatlı bilgisayarlı tomografi görüntülerinin değeri: Bir olgu sunumu

Abstract

Son dönem karaciğer hastalığında dolaşımdaki bazı mediatörlere

bağlı olarak hafif hipoksemiden hepatopulmoner sendroma

kadar uzanan spektrumda solunum komplikasyonları

görülebilmektedir. İntrapulmoner vasküler dilatasyonlar ve şantlar

bu komplikasyonlardan sorumludur. Radyografi ve bilgisayarlı

tomografi (BT) gibi toraks görüntüleme modaliteleri bu vasküler

patolojilerin değerlendirilmesinde kullanılabilir. Bu olgu

sunumunda bilinen karaciğer sirozu olan ve yeni başlayan egzersiz

dispnesi ile başvuran 37 yaşında kadın hastanın direkt grafi ve BT

bulgularından bahsettik. Hastanın toraks BT’sinde intrapulmoner

şantlar ve dilate vasküler yapılar mevcuttu. Hastamız, klinik,

laboratuvar ve radyolojik bulguları sonucunda hepatopulmoner

sendrom tanısını aldı. Kalın kesit reformatlı BT görüntüleri

intrapulmoner şantlar ve dilate vasküler yapıları kaynak görüntü

olarak kullanılan ince kesit BT’den daha iyi bir şekilde göstermiştir.

Bu nedenle siroz hastalarında, intrapulmoner şantlar ve vasküler

dilatasyonların belirlenmesinde toraks BT’lerinin reformatlı kalın

kesitlerle de değerlendirilmesini önermekteyiz.

Keywords

• Bilgisayarlı tomografi,Hepatopulmoner sendrom,Karaciğer sirozu

Thick section reformatted computed tomography images are useful for the diagnosis of hepatopulmonary syndrome: A case report

Abstract

Respiratory complications, which range from mild hypoxemia

to hepatopulmonary syndrome, can occur due to some mediators

within the circulation in end-stage liver disease. Intrapulmonary

vascular dilatations and shunts are the reasons of these

complications. Thoracic imaging modalities such as radiography

and computed tomography (CT) can be performed to evaluate

these vascular pathologies. We reported a 37-year-old woman

with previously known liver cirrhosis, presented with new onset

exertional dyspnea. There were intrapulmonary shunts and dilated

vascular structures on her thorax CT. She was diagnosed with

hepatopulmonary syndrome by clinical symptoms, laboratory and

imaging findings. Thick section reformatted images of CT are

superior in demonstration of intrapulmonary shunts and dilated

vascular structures compared with thin section axial source

images; so we recommend that thorax CT of cirrhotic patients

must be evaluated with thick section reformatted images for the

determination of intrapulmonary shunts and dilated vascular

structures.

Keywords

• Computed tomography,Hepatopulmonary syndrome,Liver cirrhosis

References

1. Kim YK, Kim Y, Shim SS. Thoracic complications of liver cirrhosis: radiologic findings. Radiographics 2009;29:825- 37. doi: 10.1148/rg.293085093
2. Fallon MB, Abrams GA. Hepatopulmonary syndrome. Curr Gastroenterol Rep 2000;2:40-5.
3. Krowka MJ, Dickson ER, Cortese DA. Hepatopulmonary syndrome: clinical observations and lack of therapeutic response to somatostatin analogue. Chest 1993;104:515-21.
4. Leung AN. Case 63: hepatopulmonary syndrome. Radiology 2003;229:64-7.
5. Krowka MJ, Porayko MK, Plevak DJ, et al. Hepatopulmonary syndrome with progressive hypoxemia as an indication for liver transplantation: case reports and literature review. Mayo Clin Proc 1997;72:44-53. doi: 10.1016/S0025- 6196(11)64729-0
6. Scott VL, Dodson SF, Kang Y. The hepatopulmonary syndrome. Surg Clin North Am 1999;79:23-41, vii.
7. McAdams HP, Erasmus J, Crockett R, Mitchell J, Godwin JD, McDermott VG. The hepatopulmonary syndrome: radiologic findings in 10 patients. AJR Am J Roentgenol 1996;166:1379-85. doi: 10.2214/ajr.166.6.8633451
8. Lee KN, Lee HJ, Shin WW, Webb WR. Hypoxemia and liver cirrhosis (hepatopulmonary syndrome) in eight patients: comparison of the central and peripheral pulmonary vasculature. Radiology 1999;211:549-53. doi: 10.1148/ radiology.211.2.r99ma46549

9. Abrams GA, Jaffe CC, Hoffer PB, Binder HJ, Fallon MB. Diagnostic utility of contrast echocardiography and lung perfusion scan in patients with hepatopulmonary syndrome. Gastroenterology 1995;109:1283-8.
10. Colle I, Van Steenkiste C, Geerts A, Van Vlierberghe H. Hepatopulmonary syndrome and portopulmonary hypertension: what’s new?. Acta Gastroenterol Belg 2007;70:203-9.