Atilla Hikmet ÇİLENGİR, Şebnem KARASU, Yusuf Kenan ÇETİNOĞLU, Muhsin Engin ULUÇ, Özgür TOSUN

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

Son dönem karaciğer hastalığında dolaşımdaki bazı mediatörlerebağlı olarak hafif hipoksemiden hepatopulmoner sendromakadar uzanan spektrumda solunum komplikasyonlarıgörülebilmektedir. İntrapulmoner vasküler dilatasyonlar ve şantlarbu komplikasyonlardan sorumludur. Radyografi ve bilgisayarlıtomografi (BT) gibi toraks görüntüleme modaliteleri bu vaskülerpatolojilerin değerlendirilmesinde kullanılabilir. Bu olgusunumunda bilinen karaciğer sirozu olan ve yeni başlayan egzersizdispnesi ile başvuran 37 yaşında kadın hastanın direkt grafi ve BTbulgularından bahsettik. Hastanın toraks BT’sinde intrapulmonerşantlar ve dilate vasküler yapılar mevcuttu. Hastamız, klinik,laboratuvar ve radyolojik bulguları sonucunda hepatopulmonersendrom tanısını aldı. Kalın kesit reformatlı BT görüntüleriintrapulmoner şantlar ve dilate vasküler yapıları kaynak görüntüolarak kullanılan ince kesit BT’den daha iyi bir şekilde göstermiştir.Bu nedenle siroz hastalarında, intrapulmoner şantlar ve vaskülerdilatasyonların belirlenmesinde toraks BT’lerinin reformatlı kalınkesitlerle de değerlendirilmesini önermekteyiz.

Anahtar Kelimeler:

Bilgisayarlı tomografi, Hepatopulmoner sendrom, Karaciğer sirozu

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

Respiratory complications, which range from mild hypoxemiato hepatopulmonary syndrome, can occur due to some mediatorswithin the circulation in end-stage liver disease. Intrapulmonaryvascular dilatations and shunts are the reasons of thesecomplications. Thoracic imaging modalities such as radiographyand computed tomography (CT) can be performed to evaluatethese vascular pathologies. We reported a 37-year-old womanwith previously known liver cirrhosis, presented with new onsetexertional dyspnea. There were intrapulmonary shunts and dilatedvascular structures on her thorax CT. She was diagnosed withhepatopulmonary syndrome by clinical symptoms, laboratory andimaging findings. Thick section reformatted images of CT aresuperior in demonstration of intrapulmonary shunts and dilatedvascular structures compared with thin section axial sourceimages; so we recommend that thorax CT of cirrhotic patientsmust be evaluated with thick section reformatted images for thedetermination of intrapulmonary shunts and dilated vascularstructures.

Keywords:

Computed tomography, Hepatopulmonary syndrome, Liver cirrhosis,

PDF

___

Kim YK, Kim Y, Shim SS. Thoracic complications of liver cirrhosis: radiologic findings. Radiographics 2009;29:825- 37. doi: 10.1148/rg.293085093
Fallon MB, Abrams GA. Hepatopulmonary syndrome. Curr Gastroenterol Rep 2000;2:40-5.
Krowka MJ, Dickson ER, Cortese DA. Hepatopulmonary syndrome: clinical observations and lack of therapeutic response to somatostatin analogue. Chest 1993;104:515-21.
Leung AN. Case 63: hepatopulmonary syndrome. Radiology 2003;229:64-7.
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
Scott VL, Dodson SF, Kang Y. The hepatopulmonary syndrome. Surg Clin North Am 1999;79:23-41, vii.
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
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
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.
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.