Reduction of intrapulmonary shunt and resolution of digital clubbing associated with primary biliary cirrhosis after liver transplantation

This report describes a patient with marked hypoxemia caused by intrapulmonary shunt associated with primary biliary cirrhosis. Liver transplantation resulted in resolution of digital clubbing and reduction of intrapulmonary shunt as demonstrated by normalization of room air arterial blood gases, reduction in shunt fraction and normalization of the indocyanin‐enhanced echocardiogram and perfusion lung scan.

[1]  R M Gardner,et al.  Reference spirometric values using techniques and equipment that meet ATS recommendations. , 2015, The American review of respiratory disease.

[2]  P. Vanhoutte The endothelium--modulator of vascular smooth-muscle tone. , 1988, The New England journal of medicine.

[3]  D. Cortese,et al.  Severe hypoxemia associated with liver disease: Mayo Clinic experience and the experimental use of almitrine bismesylate. , 1987, Mayo Clinic proceedings.

[4]  G. Danovitch,et al.  Liver transplantation today. , 1986, Annals of internal medicine.

[5]  D. Cortese,et al.  Pulmonary aspects of chronic liver disease and liver transplantation. , 1985, Mayo Clinic proceedings.

[6]  J. Thrall,et al.  Radionuclide demonstration of intrapulmonary shunting in cirrhosis. , 1983, AJR. American journal of roentgenology.

[7]  R. Hughes,et al.  CONTROLLED TRIAL OF PREDNISOLONE IN ACUTE POLYNEUROPATHY , 1978, The Lancet.

[8]  M. Brachman,et al.  Hypoxemia of cirrhosis: detection of abnormal small pulmonary vascular channels by a quantitative radionuclide method. , 1977, American Journal of Medicine.

[9]  D. G. Ritter,et al.  Peripheral venous contrast echocardiography. , 1977, The American journal of cardiology.

[10]  G. Taplin,et al.  An intravenous radionuclide method to evaluate hypoxemia caused by abnormal alveolar vessels. Limitation of conventional techniques. , 1976, The American review of respiratory disease.

[11]  N. Stanley,et al.  Mottled chest radiograph and gas transfer defect in chronic liver disease , 1972, Thorax.

[12]  S. Chiang A nomogram for venous shunt (Qs/Qt) calculation , 1968, Thorax.

[13]  R. Sapru,et al.  Cirrhosis, cyanosis and polycythaemia: multiple pulmonary arteriovenous anastomoses. , 1968, The American journal of medicine.

[14]  T. Starzl,et al.  Extended survival in 3 cases of orthotopic homotransplantation of the human liver. , 1968, Surgery.

[15]  L. Wickstrom,et al.  SALMONELLAS IN MEAT. , 1964, Lancet.

[16]  D. S. Fischer,et al.  CLUBBING, A REVIEW, WITH EMPHASIS ON HEREDITARY ACROPACHY , 1964, Medicine.

[17]  N. Tygstrup,et al.  SOURCES OF VENOARTERIAL ADMIXTURE IN PORTAL HYPERTENSION. , 1963, The Journal of clinical investigation.

[18]  Hall Gh,et al.  Further experimental evidence implicating reduced ferritin as a cause of digital clubbing. , 1963 .

[19]  H. Stein,et al.  Digital clubbing in cirrhosis of the liver. , 1961, Lancet.

[20]  Bashour Fa Clubbing of the digits: physiologic considerations. , 1961 .

[21]  B. Pastor,et al.  CYANOSIS, CLUBBING AND ARTERIAL OXYGEN UNSATURATION ASSOCIATED WITH LAENNEC'S CIRRHOSIS , 1959, The American journal of the medical sciences.

[22]  G. H. Hall The cause of digital clubbing; testing a new hypothesis. , 1959, Lancet.

[23]  S. Sherlock,et al.  Circulatory changes in chronic liver disease. , 1958, The American journal of medicine.

[24]  W. Abelmann,et al.  Porto-caval and porto-pulmonary anastomoses in Laennec's cirrhosis and in heart failure. , 1957, The Journal of clinical investigation.

[25]  F. W. Hoffbauer,et al.  Multiple pulmonary arteriovenous fistulas in juvenile cirrhosis. , 1956, The American journal of medicine.

[26]  G. Wilson Local circulatory changes associated with clubbing of the fingers and toes. , 1952, The Quarterly journal of medicine.

[27]  B. Zweifach,et al.  Hepatorenal Factors in Circulatory Homeostasis: IV. Tissue Origins of the Vasotropic Principles, VEM and VDM, Which Appear during Evolution of Hemorrhagic and Tourniquet Shock , 1951, Circulation.

[28]  J. T. Shepherd,et al.  Vasodilatation : vascular smooth muscle, peptides, autonomic nerves, and endothelium , 1988 .

[29]  D. V. van Thiel,et al.  Medical Aspects of Liver Transplantation , 1984, Hepatology.

[30]  J. Moller,et al.  Syndrome of cyanosis, digital clubbing, and hepatic disease in siblings. , 1968, The Journal of pediatrics.

[31]  C. D. Laidlaw,et al.  Further experimental evidence implicating reduced ferritin as a cause of digital clubbing. , 1963, Clinical science.

[32]  F. Bashour Clubbing of the digits: physiologic considerations. , 1961, The Journal of laboratory and clinical medicine.