Chest
Volume 72, Issue 3, September 1977, Pages 305-309
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Clinical Investigations
Exercise-Aggravated Hypoxemia and Orthodeoxia in Cirrhosis

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A syndrome characterized by hypoxemia aggravated by exercise, orthodeoxia, hypocapnia, and evidence of hyperdynamic circulation, but otherwise normal indices of pulmonary air flow, volume, and distribution of ventilation has been observed as an infrequent complication of hepatic cirrhosis. An illustrative case is described, the features of which support the presence of a shunt or shunt-like mechanism consisting of low-resistance vascular communications within the lung. We suggest that this may represent the existence of a hepatopulmonary syndrome analogous to the hepatorenal syndrome.

Section snippets

CASE REPORT

A 63-year-old white man was first admitted to the Tucson Veterans Administration Hospital for alcoholic cirrhosis in 1968. The diagnosis was confirmed by biopsy. The early course of his disease was complicated by multiple episodes of hemorrhage from esophageal varices. In 1969, a side-to-side portacaval anastomosis was performed, after which the patient suffered no recurrence of bleeding. He markedly reduced his consumption of alcohol and did well until 1973. Persistent elevation of the

DISCUSSION

Several theories regarding the mechanism of arterial hypoxemia associated with hepatic cirrhosis were advanced between 1948 and 1968. Most investigators agree that the data suggest some mechanism of right-to-left venoarterial shunting, but there exists some disagreement as to the mechanism of venous admixture. Some5,8,13 have suggested the existence of a portopulmonary pathway via esophageal and mediastinal collateral veins. The evidence for this was derived from postmortem injection studies5

ACKNOWLEDGMENT

We would like to acknowledge the cooperation of Dr. Charles L. Witte in allowing us to evaluate this interesting patient.

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    Manuscript received July 15; revision accepted December 30.

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