Hepatopulmonary syndrome other imaging findings

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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

Angiography may be helpful in the diagnosis of hepatopulmonary syndrome. Non-invasive studies are preferred in diagnosis and management of patients with hepatopulmonary syndrome. Pulmonary angiography is indicated in known cases of HPS if sever hypoxia (partial pressure of oxygen is < 60 mmHg) is present, if the patient is a poor responsive to 100% oxygen, and if there is a strong suspicion of direct arterio-venous communications that would be amenable to embolization, based on chest CT scan findings. Rather than direct visualization of the pulmonary dilations (IPVSs), it can also demonstrate type of micro dilation in pulmonary vasculture.

Other Imaging Findings

Pulmonary angiography

Non-invasive studies are preferred in diagnosis and management of patients with hepatopulmonary syndrome. Nevertheless in some cases such as likelihood of tromobotic accident, or when other noninvasive studies were not diagnostic, it is needed to evaluate the patient by means of angiography.

Indication for pulmonary angiography in known cases of HPS are as follows:

• Sever hypoxia (partial pressure of oxygen is < 60 mmHg),
• Poor response to 100% oxygen
• Strong suspicion of direct arterio-venous communications that would be amenable to embolization, based on chest CT scan findings.

Rather than direct visualization of the pulmonary dilations (IPVSs), it can also demonstrate type of micro dilation in pulmonary vasculture as follows:

• Type 1 (minimal):Finely diffuse, spidery infiltrates; may progress to type 1 (advanced).
• Type 1 (advanced): Diffuse spongy or blotchy angiographic appearance
• Type 2: Discrete, localized arterio-venous communications

Technetium 99m-labeled macroaggregated albumin scanning