Contrast echocardiography in detection of portopulmonary venous anastomosis

Sano, Akira; Nishizawa, Satoshi; Sasai, Kazuhiko; Imanaka, Kazuhito; Tanaka, Kōichi; Hashimura, T; Iida, Ayako; Ban, Nenad; Moriyasu, F; Takahashi, Yasuhiro; et, al

doi:10.2214/ajr.142.1.137

Cited by 15 publications

(19 citation statements)

References 16 publications

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“…However, portopulmonary venous anastomosis is typically detected during transhepatic portography rather than saline contrast echocardiography because it provides enough contrast echoes to be picked up even at a location distant from the injection site. 5 This explains the negative contrast echocardiography study in our case.…”

Section: Discussionsupporting

confidence: 66%

“…3,4 Portopulmonary venous anastomosis has been recognized as one of the cephalad hepatofugal collaterals in patients with portal hypertension. 5 Portopulmonary venous anastomosis was first reported by Schoenmackers and Vieten in 1953. 6 Incidences have been reported to be 1-30% in portal hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…6 Incidences have been reported to be 1-30% in portal hypertension. 5,7,8 In previous reports, portopulmonary venous anastomosis was detected on postmortem angiography and percutaneous transhepatic portography. However, computed tomography imaging of direct portopulmonary shunts has not been described in the literature.…”

Section: Discussionmentioning

confidence: 99%

“…These results allow realtime differential diagnosis of portopulmonary venous anastomosis from other causes of intrapulmonary shunt. 5 As the portal vein carries deoxygenated blood, portopulmonary venous anastomosis causes venous admixture, resulting in a significant reduction in arterial oxygen saturation, especially when the portal venous blood has very low oxygen saturation and/or the shunt is large enough to carry a significant amount of cardiac output. 8,12 The hemodynamics in such cases involves a functional right-toleft shunt.…”

Section: Discussionmentioning

confidence: 99%

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An Unusual Cause of Refractory Hypoxemia in Cirrhosis

Patidar¹,

Kumar

2014

Respir Care

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Pulmonary gas exchange abnormalities and refractory hypoxemia cause myriad difficulties in patients with chronic liver disease. In addition to intrinsic cardiopulmonary diseases and hepatopulmonary syndrome, some unusual pathophysiological mechanisms in patients with portosystemic collaterals might contribute to hypoxemia. We report the clinical presentation of an unusual portosystemic anatomic shunt that permits venous admixture with oxygenated blood, causing hypoxemia that is refractory to the administration of supplemental oxygen, and recurrent hepatic encephalopathy. There has been no such report in the published literature. This case highlights the importance of keeping direct portopulmonary venous anastomosis in the differential diagnosis of oxygen-refractory hypoxemia and recurrent hepatic encephalopathy in patients with cirrhosis in the appropriate clinical context.

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Section: Discussionsupporting

confidence: 66%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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An Unusual Cause of Refractory Hypoxemia in Cirrhosis

Patidar¹,

Kumar

2014

Respir Care

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“…Eight articles [3,[6][7][8][9][10][11][12] were relevant to this "frequency" question. Each of these articles describes a series of subjects with cirrhosis who were investigated with a technique capable of proving the presence or absence of a PPVA (Table 1).…”

Section: Among Patients With Advanced Cirrhosis What Is the Frequencmentioning

confidence: 99%