Detección del shunt intrapulmonar en pacientes con cirrosis hepática mediante doppler transcraneal con contraste. Estudio de prevalencia, caracterización del patrón y validez diagnóstica

Moreno, Juan Mozas; Núñez, María Victoria Millán; Carrasco, Marta Rodríguez; Ceberino, D.; Romaskevych-Kryvulya, Olena; Silva, Ana Belén Constantino; Muñoz-Vega, Pedro; García-Corrales, Carmen; Guiberteau-Sánchez, Ana; Montero, Ana Roa; Márquez-Lozano, Patricia; Rodríguez, Isidoro Narváez

doi:10.1016/j.gastrohep.2015.02.006

Cited by 7 publications

(5 citation statements)

References 39 publications

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“…Contrast-enhanced transcranial Doppler (TCD) of the bilateral middle cerebral arteries after the injection of agitated saline is an ultrasound technique, similar to transthoracic or transesophageal echocardiography, that can be performed to detect microbubbles and diagnose intracardiac or intrapulmonary shunt ( Figure 1 ) ( 4 , 5 ). TCD is more sensitive than transthoracic echocardiography in detecting right-to-left shunt, ( 6 ) and it is less invasive than transesophageal echocardiography.…”

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confidence: 99%

“…These data suggest that pulmonary vasodilatations may explain the disproportionate hypoxemia in some patients with COVID-19 pneumonia and, somewhat surprisingly, track with poor lung compliance ( 1 ). Our detection of transpulmonary bubbles may be analogous to hepatopulmonary syndrome, a pulmonary vascular disorder of chronic liver disease characterized by pulmonary vascular dilatations with increased blood flow to affected lung units, which results in ventilation–perfusion mismatch and hypoxemia ( 4 ). The normal lung filters microbubbles from the injection of agitated saline as the bubble diameter is larger (smallest bubble approximately 24 μm in diameter [ 5 ]) than the normal pulmonary capillary (<15 μm in diameter [ 7 ]).…”

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confidence: 99%

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Pulmonary Vascular Dilatation Detected by Automated Transcranial Doppler in COVID-19 Pneumonia

Reynolds

Lee

Renz³

et al. 2020

Am J Respir Crit Care Med

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Some patients with coronavirus disease (COVID-19) pneumonia demonstrate severe hypoxemia despite having near normal lung compliance, a combination not commonly seen in typical acute respiratory distress syndrome (ARDS) (1). The disconnect between gas exchange and lung mechanics in COVID-19 pneumonia has raised the question of whether the mechanisms of hypoxemia in COVID-19 pneumonia differ from those in classical ARDS. Dual-energy computed tomographic imaging has demonstrated pulmonary vessel dilatation (2) and autopsies have shown pulmonary capillary deformation (3) in patients with COVID-19 pneumonia. Contrast-enhanced transcranial Doppler (TCD) of the bilateral middle cerebral arteries after the injection of agitated saline is an This article is open access and distributed under the terms of the Creative Commons Attribution Non-Commercial No Derivatives License 4.

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confidence: 99%

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confidence: 99%

Pulmonary Vascular Dilatation Detected by Automated Transcranial Doppler in COVID-19 Pneumonia

Reynolds

Lee

Renz³

et al. 2020

Am J Respir Crit Care Med

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“…AIS may also be due to rupture of a carotid plaque, carotid thrombosis, or the development of atrial fibrillation induced by the inflammatory response. Invasion of endothelial cells by the COVID-19 virus with inflammation and apoptosis of endothelial cells has been shown to occur in renal, cardiac, gastrointestinal, and pulmonary tissue at autopsy, but not in cerebral tissue [12]. These remarkable findings may offer insights into the mechanisms of presumed idiopathic or cryptogenic ischemic strokes in non-COVID-19 ischemic stroke patients.…”

Section: Discussionmentioning

confidence: 96%

“…This was also reflected by lower P/F ratios, reflecting severe hypoxemia. They pointed out that this phenomenon is akin to the hepatopulmonary syndrome, a condition characterized by pulmonary vascular vasodilatation and ventilation-perfusion mismatch, leading to hypoxia in patients with chronic liver disease [12,13]. This phenomenon of pulmonary shunting of micro-emboli is seen in only 26% of patients with classic adult respiratory distress syndrome [14].…”

Section: Discussionmentioning

confidence: 99%

COVID-19-Induced Ischemic Infarcts With Normal Coagulation Profile and Excellent Outcome: A Case Report With Highlights on the Thrombotic Diathesis, Recent Transcranial Doppler Findings, and Neuropathology Update

Kesserwani

2021

Cureus

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We present the case of a previously healthy 41-year-old man right-handed man diagnosed with coronavirus disease 2019 (COVID-19) who developed multiple cortical ischemic infarcts. Our patient developed mild neurologic deficits despite the total volume of cerebral ischemic lesions, presumably due to involvement of non-eloquent cortex, the integrity of the collateral circulation due to his youth and good health, and mild COVID-19 disease without any significant pulmonary involvement. We discuss the coagulopathy and direct vascular effects, if any, of COVID-19 disease and compare it to other agents such as the filovirus, ad Ebola. We also outline the recent intriguing findings of vasodilation of the pulmonary vessels and the potential shunting of micro-emboli into the brain, which may explain the formation of embolic ischemic infarcts in even mild disease. Lastly, we discuss the neuropathology of COVID-19 in patients that who have succumbed to the disease and note the striking lack of direct involvement of the cerebral blood vessels.

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“…It was found that PTT may be a useful parameter for evaluating arterial oxygenation in patients with chronic liver disease with early HPS ( 23 ). Another study also revealed that contrast enhanced transcranial Doppler was more sensitive for the detection of IPVD with a low false positive rate ( 24 ).…”

Section: Progress In Contrast Enhanced Echocardiography (Cee) For the Diagnosis Of Hpsmentioning

confidence: 99%

Advances in Diagnostic Imaging of Hepatopulmonary Syndrome

Luo

2022

Front. Med.

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Hepatopulmonary syndrome (HPS) is a serious pulmonary complication of progressive liver disease that leads to a poor clinical prognosis. Patients with HPS may develop acute respiratory failure, which requires intensive care and therapy. At present, the only effective treatment is liver transplantation; therefore, early diagnosis and timely treatment are of considerable significance. The three main features of HPS are liver disease, oxygenation disorder, and intrapulmonary vascular dilatation (IPVD). Diagnosing HPS is challenging due to the difficulty in detecting the presence or absence of IPVD. As such, imaging examination is very important for detecting IPVD. This paper reviews the imaging methods for diagnosing HPS such as ultrasound, dynamic pulmonary perfusion imaging, pulmonary angiography, and computed tomography.

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Detección del shunt intrapulmonar en pacientes con cirrosis hepática mediante doppler transcraneal con contraste. Estudio de prevalencia, caracterización del patrón y validez diagnóstica

Cited by 7 publications

References 39 publications

Pulmonary Vascular Dilatation Detected by Automated Transcranial Doppler in COVID-19 Pneumonia

Pulmonary Vascular Dilatation Detected by Automated Transcranial Doppler in COVID-19 Pneumonia

COVID-19-Induced Ischemic Infarcts With Normal Coagulation Profile and Excellent Outcome: A Case Report With Highlights on the Thrombotic Diathesis, Recent Transcranial Doppler Findings, and Neuropathology Update

Advances in Diagnostic Imaging of Hepatopulmonary Syndrome

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