Resolution of Hepatopulmonary Syndrome After Methadone Withdrawal as Demonstrated by Right to Left Shunt Study

Abstract

We present the right to left shunt study findings of a 50-year-old male patient with hepatitis C cirrhosis, who complained of worsening dyspnea on exertion. Follow-up images showed resolution of hepatopulmonary syndrome following methadone withdrawal although there had been no improvement in his liver disease. This was unusual and may have been due to the effect of opiate receptors on nitric oxide signaling in the pulmonary vasculature.

The hepatopulmonary syndrome

“…The authors hypothesize a role for opiate receptors in modulating NO signaling and release as the pathophysiologic mechanism for the effects [82,83]. Both patients had hepatitis C as the cause for their underlying liver disease; one of them achieved sustained virologic response after interferon and ribavirin therapy, 3 years prior to the resolution of the syndrome.…”