Hepatopulmonary syndrome echocardiography and ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

There are no echocardiography/ultrasound findings associated with hepatopulmonary syndrome.

OR

Echocardiography/ultrasound may be helpful in the diagnosis of hepatopulmonary syndrome. Findings on an echocardiography/ultrasound suggestive of/diagnostic of hepatopulmonary syndrome include [finding 1], [finding 2], and [finding 3].

OR

There are no echocardiography/ultrasound findings associated with hepatopulmonary syndrome. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of hepatopulmonary syndrome, which include [complication 1], [complication 2], and [complication 3].

Echocardiography/Ultrasound

• Transthoracic echocardiography
• Contrast-enhanced transthoracic echocardiography with agitated saline is the most practical method to detect pulmonary vascular dilation.
• The agitated saline is administered in a peripheral vein in the patient’s arm, exceed the normal pulmonary capillary diameter and should be trapped normally.
• In normal physiologic status, particles greater than 20 microns in diameter, (normal range of pulmonary capillary diameter is less than 8 to 15 microns) are trapped and filtered by the pulmonary capillary bed and do not appear in the left side of the heart and general circulation.
• However, in the presence of an intrapulmonary or intracardiac right-to-left shunt, those particles may be detected either in the left heart chambers or in the other organs such as brain or kidneys.
• Contrast-enhanced transthoracic echocardiography could distinguish between intracardiac and intrapulmonary shunt.
• The timing of the appearance of the left-sided bubbles after injection can determine the source of shunt.
• In intracardiac shunting: three cardiac cycles after the appearance of the bubbles in the right heart chambers.
• In intrapulmonary shunting: four to six cardiac cycles after the appearance of the bubbles in the right heart chambers.

Transesophageal echocardiography

It should also be noted that transesophageal echocardiography can also be used to detect intrapulmonary vascular dilations with greater specificity due to the direct visualization of microbubbles in the pulmonary veins as they enter the left atrium, though this technique is more invasive. This transthoracic, qualitative approach is more sensitive than the injection of technetium 99m-labeled macroaggregated albumin and less invasive than pulmonary angiography. The additional benefit is that cardiac function and pulmonary artery pressures can also be evaluated.

There are no echocardiography/ultrasound findings associated with hepatopulmonary syndrome.

OR

Echocardiography/ultrasound may be helpful in the diagnosis of hepatopulmonary syndrome. Findings on an echocardiography/ultrasound suggestive of/diagnostic of hepatopulmonary syndrome include:

• [Finding 1]
• [Finding 2]
• [Finding 3]

OR

There are no echocardiography/ultrasound findings associated with hepatopulmonary syndrome. However, an echocardiography/ultrasound may be helpful in the diagnosis of complications of hepatopulmonary syndrome, which include:

• [Complication 1]
• [Complication 2]
• [Complication 3]