Prolonged Unexplained Hypoxemia as Initial Presentation of Cirrhosis: A Case Report

Abstract

Patient: Male, 43Final Diagnosis: Hepatopulmonary syndromeSymptoms: DyspneaMedication: —Clinical Procedure: —Specialty: Gastroenterology and HepatologyObjective:Unusual clinical courseBackground:Hepatopulmonary syndrome (HPS) is a pulmonary complication of advanced liver disease with dyspnea as the predominant presenting symptom. The diagnosis of HPS can often be missed due to its nonspecific presentation and the presence of other comorbidities.Case Report:We present an interesting case of an obese 43-year-old man who presented with progressive, unexplained hypoxemia and shortness of breath in the absence of any symptoms or signs of chronic liver disease. After extensive cardiopulmonary investigations, he was diagnosed with severe HPS as a result of non-alcoholic steatohepatitis (NASH) leading to cirrhosis. He subsequently underwent successful hepatic transplantation and continues to improve at 12-month follow-up.Conclusions:HPS needs to be considered in the differential diagnosis of unexplained hypoxemia. Given its poor prognosis, early diagnosis is warranted and treatment with liver transplantation is the preferred choice.

Persistent Unexplained Dyspnea: A Case of Hepatopulmonary Syndrome

“…The diagnosis, based on the classic triad of hepatic disease, arterial deoxygenation, and intrapulmonary vascular dilatation (IPVD) [7], can often be missed due to nonspecific presentation and presence of other comorbidities [8]. Our case well illustrates this challenging situation.…”

In vivo photoacoustic assessment of the oxygen saturation changes in the human radial artery: a preliminary study associated with age

“…Oxygen metabolism is tightly regulated in the body because hypoxemia (abnormally low blood oxygen level) can lead to acute adverse effects in several organ systems. 10,[12][13][14][15] Recently, the decreased sO 2 of COVID-19 patients measured at hospital admission was reported as one of the strongest predictors of critical illness, with silent hypoxia concurrently occurring with other symptoms such as shortness of breath. [16][17][18] In general, clinical sO 2 measurements are conducted using a pulse oximeter that attaches at the tip of the patient's finger and is based on optical spectral differences between oxyhemoglobin (HbO) and deoxyhemoglobin (HbD).…”