Thoracic Complications of Liver Cirrhosis: Radiologic Findings

Abstract

Patients with chronic liver disease exhibit various cardiovascular and pulmonary complications. Hepatopulmonary syndrome results in dyspnea due to intrapulmonary arteriovenous shunting and ventilation-perfusion mismatch. Portopulmonary hypertension occurs in patients with portal hypertension. Intrathoracic portosystemic collateral vascular pathways develop in patients with portal hypertension to allow decompression of the portal vein into the systemic circulation. Hepatic hydrothorax may develop in patients with cirrhosis and ascites. Massive necrosis of the liver from any cause may be associated with acute hypoxic respiratory failure, necessitating ventilatory support. Bacterial infection is common in cirrhotic patients because of a compromised host defense system. Hepatocellular carcinoma may produce hematogenous lung metastases, intrathoracic lymph node metastases, direct intracardiac extension, and pulmonary embolism. Interferon therapy for treatment of chronic active hepatitis C may disturb cellular immune activation in some patients and contribute to the onset and progression of sarcoidosis. Awareness of the various thoracic manifestations in chronic liver disease can be helpful for making a differential diagnosis and planning proper management.

Portopulmonary Hypertension

“…2A). 30,31 Findings suggestive of pulmonary hypertension on CT of the chest include increased pulmonary artery diameter, particularly if it is greater than the diameter of the aorta, and increased segmental artery-to-bronchus ratios in multiple pulmonary lobes (Figs. 2B, C).…”

“…Lung perfusion testing may also show multiple patchy defects in the setting of severe pulmonary hypertension. 31 Electrocardiography Abnormal electrocardiogram findings most commonly associated with POPH include right ventricular hypertrophy and right axis deviation. 30 Right and left atrial abnormality or enlargement, right bundle branch block and first-degree atrioventricular block may also be seen.…”

Thick section reformatted computed tomography images are useful for the diagnosis of hepatopulmonary syndrome: A case report

“…The prevalence of hepatopulmonary syndrome in adult cirrhotic patients ranges between 15-20% [1]. Krowka et al, found that dyspnea is the presenting symptom in 18% of the patients [3].…”

“…The most common type (type 1), which includes 86% of the patients, is characterized by subpleural telangiectasia and peripheral vascular dilatation. Type 2 hepatopulmonary syndrome (14% of patients) is characterized by arteriovenous malformations and nodular dilatations in peripheral pulmonary arteries [1,3,7]. …”

“…In the end-stage disease, many systems can be affected and also respiratory complications can be seen. Mild hypoxemia is a frequent feature of cirrhosis but dyspnea and hepatopulmonary syndrome are seen in only 15-20% of the patients with cirrhosis [1]. In hepatopulmonary syndrome; peripheral tissue oxygenation is impaired due to intrapulmonary vascular dilatations and shunts.…”