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

• 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 the 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.

• More sensitive than technetium 99m-labeled macroaggregated albumin test
• less invasive than pulmonary angiography. and transesophageal echocardiography (TTE)

Transesophageal echocardiography

Findings on an echocardiography/ultrasound suggestive of/diagnostic of hepatopulmonary syndrome include:

• Transesophageal echocardiography (TTE) is also helpful in the diagnosis of hepatopulmonary syndrome.
• TTE can detect intrapulmonary vascular dilations with greater specificity compared to transthoracic echocardiography since the examiner can directly observe microbubbles in the pulmonary veins as they enter the left atrium.
• Additionally, cardiac function, and pulmonary artery pressures can also be evaluated.

Limitations

• More invasive compared to transthoracic echocardiography