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Diffuse Lung Disease |

Cryptogenic Organizing Pneumonia in a Patient With Hepatopulmonary Syndrome

Ivan Romero-Legro*, MD
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University of Tennessee, Memphis, TN


Chest. 2012;142(4_MeetingAbstracts):480A. doi:10.1378/chest.1390819
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Abstract

SESSION TYPE: ILD Case Report Posters

PRESENTED ON: Tuesday, October 23, 2012 at 01:30 PM - 02:30 PM

INTRODUCTION: Respiratory symptoms are common in patients who have chronic liver disease, the differential diagnosis of dyspnea is broad in these patients, and there are numerous causes to consider like pulmonary vascular disorders. The hepatopulmonary syndrome occurs when intrapulmonary vasodilatation impairs arterial gas exchange but other reason rare etilogies can be present like COP.

CASE PRESENTATION: 48-year-old Caucasian female with a history of cirrhosis due to hepatitis C presented with complaints of worsening dyspnea, fever and cough. CXR suggested LLL pneumonia and right pleural effusion. Antibiotics were started and pleural fluid was compatible with an exudate. Despite treatment patient continued with fever and more hypoxemia. She was intubated due to severe hypoxemia and mental status changes due to hepatic encephalopathy . Hepatopulmonary syndrome was diagnosed with their three components, liver disease, pulmonary vascular dilatation, and a defect in oxygenation. Patient condition was worsening now with ARDS from unknown etiology, started on steroids and ardsnet recommendations. TBBX was done when she was stable and biopsy was compatible with COP. She did response to steroids and was successfully extubated.

DISCUSSION: Hypoxemia is common in the context of hepatic disease; its cause is often multifactorial. Advanced liver disease is associated with several pulmonary complications, pleural complications or both in this case; ascites, hepatic hydrothorax and hepatopulmonary syndrome that was complicated with COP, a not frequent etiology of dyspnea in liver disease.

CONCLUSIONS: The differential diagnosis of dyspnea is broad in the general population and there are additional syndromes to consider in patients with liver disease HPS is defined as an arterial oxygenation defect induced by intrapulmonary vascular dilatations in the setting of liver disease. Glucocorticoid therapy induces rapid clinical improvement and clearing of the opacities on chest imaging, usually without significant sequelae.

1) N Engl J Med 2008;358:2378-87.

2) Eur Respir J. 2006;28(2):422.

DISCLOSURE: The following authors have nothing to disclose: Ivan Romero-Legro

No Product/Research Disclosure Information

University of Tennessee, Memphis, TN

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