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Platypnea orthodeoxia pathophysiology on screen

Journal of Geriatric Cardiology 2014年第2期11卷 174-174页

作者： Gianluca Rigatelli Paolo Cardaioli Mauro Chinaglia Cardiovascular Diagnosis and Endoluminal Interventions Rovigo General Hospital 45100 Rovigo Italy Department of Neurovascular Sciences Rovigo General Hospital 45100 Rovigo Italy

A 64-year-old lady lying in supine position because multiple sclerosis, suffered a major stroke with no other plausible reasons but a hugc right-to-left shunt confirmed by transthoracic echocardiography as a patent foramen ovale （PFO） with atrial septal aneurysm （ASA）. Further examination with transesophageal echocardiography was not possible because of hostile esophageal tract. During rehabilitation exercise protocol in upright position, the patient developed severe dyspnoea and hypoxaemia. The patient was taken into the catheterization lab and a right heart catheterization with intracardiac echocardiography and eventual closure of the interatrial communication was planned.

关键词： Dyspnoea Echocardiography orthodeoxia

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Reversion of severe hepatopulmonary syndrome in a non cirrhotic patient after corticosteroid treatment for granulomatous hepatitis:A case report and review of the literature

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World Journal of Gastroenterology 2006年第2期12卷 336-339页

作者： Nikolaos Tzovaras Aggelos Stefos Sarah P Georgiadou Nikolaos Gatselis Georgia Papadamou Eirini Rigopoulou Maria Ioannou Ioannis Skoularigis Georgios N Dalekos Department of Medicine Academic Liver UnitMedical SchoolUniversity of Thessaly41222 LarissaGreece Department of Pathology Medical SchoolUniversity of Thessaly41222 LarissaGreece Division of Cardiology Medical SchoolUniversity of Thessaly41222 LarissaGreece

Hepatopulmonary syndrome （HPS） is defined as a clinical triad including liver disease, abnormal pulmonary gas exchange and evidence of intrapulmonary vascular dilatations. We report a 61-year-old male presented with fatigue, long-lasting fever, loss of weight, signs of portal hypertension, hepatosplenomegaly, cholestasis and progressive dyspnoea over the last year. Clinical, laboratory and histological findings confirmed the diagnosis of granulomatous hepatitis. HPS due to hepatic granulomainduced portal hypertension was proved to be the cause of severe hypoxemia of the patient as confirmed by contrast-enhanced echocardiography. Reversion of HPS after corticosteroid therapy was confirmed by a new contrastenhanced echocardiography along with the normalization of cholestatic enzymes and improvement of the patient＇ s conditions. This is the first case of complete reversion of HPS in a non-cirrhotic patient with hepatic granuloma, indicating that intrapulmonary shunt in liver diseases is a functional phenomenon and HPS can be developed even in miscellaneous liver involvement as in this case.

关键词： Hepatopulmonary syndrome Granulomatous hepatitis Liver cirrhosis orthodeoxia Platypnoea

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An unusual cause of dyspnoea complicating right upper abdominal swelling

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World Journal of Gastroenterology 2006年第25期12卷 4109-4111页

作者： Sanjay Kumar Mandal Partha Pratim Chakraborty Rana Bhattacharjee Subhasis Roy Chowdhury Shounak Majumdar Department of Medicine Medical College Kolkata88College StreetKolkataWest BengalIndia

A middle aged, non-addict male presented with right upper abdominal pain and swelling with respiratory distress. Examination revealed central cyanosis, bipedal pitting edema with prominent epigastric and back veins. Liver was enlarged, tender, spanned 20 cm without any splenomegaly or ascites. Other systems were clinically normal. Laboratory investigations showed polymorphonuclear leucocytosis with slightly deranged liver function. Abdominal ultrasonography showed an abscess in the right lobe of the liver with compressed inferior vena cava （IVC）, middle and left hepatic veins. Arterial blood gas （ABG） documented hypoxia with orthodeoxia and air-contrast echocardiography was suggestive of an intrapulmonary shunt. A diagnosis of hepato-pulmonary syndrome （HPS） was made with near normal liver function secondary to amebic liver abscess. It reversed completely following successful treatment of the liver abscess.

关键词： A-a O2 gradient Air contrast echocardiography Hepato-pulmonary syndrome orthodeoxia Amoebic liver abscess

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