Alveolar-capillary oxygen disequilibrium in hepatic cirrhosis.

Hypoxemia is a frequent occurrence in patients with severe hepatic disease. Multiple mechanisms have been implicated in the production of such hypoxemia. The case of a 35-year-old man with cyanosis, clubbing, and cirrhosis is presented. Physiologic data from this patient revealed normal pulmonary function, except for a low diffusing capacity and a 28 percent shunt while the patient was breathing 100 percent oxygen. A perfusion scan with radioactive 99mtechnetium-labelled macroaggregated albumin revealed 67 percent of the labelled macroaggregated albumin in the systemic circulation. Post-mortem examination demonstrated normal pulmonary parenchyma, markedly dilated intraparenchymal capillaries and arterioles, subpleural angiomata, and cirrhosis. No anatomic arteriovenous connections were demonstrated before or after death. We conclude that the arterial hypoxemia of some patients with hepatic cirrhosis results from dilated gas-exchanging blood vessels. These widened vessels prevent end pulmonary capillary oxygen tension from reaching equilibrium with alveolar gas, perhaps because of the widened distance for diffusion.

[1]  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.

[2]  A. Funahashi,et al.  Hypoxaemia and cirrhosis of the liver. , 1976, Thorax.

[3]  E. Robin,et al.  Platypnea related to orthodeoxia caused by true vascular lung shunts. , 1976, The New England journal of medicine.

[4]  N. Stanley,et al.  Lung Perfusion Scanning in Hepatic Cirrhosis , 1972, British medical journal.

[5]  J. Milic-Emili,et al.  Regional lung function in patients with hepatic cirrhosis. , 1971, The Journal of clinical investigation.

[6]  E. Scarpelli,et al.  Hepatogenic cyanosis: arteriovenous shunts in chronic active hepatitis. , 1971, The Journal of pediatrics.

[7]  J. Charnley.  Training of Surgeons , 1968 .

[8]  Karetzky Ms,et al.  The cause of hyperventilation and arterial hypoxia in patients with cirrhosis of the liver. , 1967 .

[9]  S. Sherlock,et al.  Cyanosis with hepatic cirrhosis , 1967, Thorax.

[10]  F. Bashour,et al.  Alveolar-arterial oxygen tension gradients in cirrhosis of the liver. Further evidence of existing pulmonary arteriovenous shunting. , 1966, American heart journal.

[11]  C. E. Tobin.  Arteriovenous shunts in the peropheral pulmonary circulation in the human lung. , 1966, Thorax.

[12]  J. G. Walker,et al.  Arterial changes in the lungs in cirrhosis of the liver--lung spider nevi. , 1966, The New England journal of medicine.

[13]  Massumi Ra,et al.  Hemodynamic abnormalities and venous admixture in portal cirrhosis. , 1965 .

[14]  H. Fritts,et al.  Systemic circulatory adjustments in hepatic disease. , 1963, The Medical clinics of North America.

[15]  T. Rodman,et al.  Arterial oxygen unsaturation and the ventilation-perfusion defect of Laennec's cirrhosis. , 1960, The New England journal of medicine.

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

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

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

[19]  A. Keys,et al.  RESPIRATORY PROPERTIES OF THE ARTERIAL BLOOD IN NORMAL MAN AND IN PATIENTS WITH DISEASE OF THE LIVER: POSITION OF THE OXYGEN DISSOCIATION CURVE. , 1938, The Journal of clinical investigation.