Tuberculosis and Respiratory Diseases

The Korean Academy of Tuberculosis and Respiratory Diseases (대한결핵및호흡기학회)
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A Case of Hepatopulmonary Syndrome in a Patient with Child-Pugh Class A Liver Cirrhosis

Child-Pugh 분류 A군 간경화에 수반된 간폐증후군 1예

  • Kim, Jung Sun (Department of Internal Medicine, Korea University College of Medicine) ;
  • Kim, Changhwan (Department of Internal Medicine and Sejong Medical Research Institute, Sejong General Hospital) ;
  • Kim, Gye Su (Department of Internal Medicine and Sejong Medical Research Institute, Sejong General Hospital) ;
  • Lim, Dal Soo (Department of Internal Medicine and Sejong Medical Research Institute, Sejong General Hospital) ;
  • Hwang, Hweung Kon (Department of Internal Medicine and Sejong Medical Research Institute, Sejong General Hospital) ;
  • Ro, Young Moo (Department of Internal Medicine and Sejong Medical Research Institute, Sejong General Hospital)
  • 김정선 (고려대학교 의과대학 내과학교실) ;
  • 김창환 (세종병원 내과 및 세종의학연구소) ;
  • 김계수 (세종병원 내과 및 세종의학연구소) ;
  • 임달수 (세종병원 내과 및 세종의학연구소) ;
  • 황흥곤 (세종병원 내과 및 세종의학연구소) ;
  • 노영무 (세종병원 내과 및 세종의학연구소)
  • Received : 2008.11.03
  • Accepted : 2008.12.01
  • Published : 2009.01.30
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Abstract

Hepatopulmonary syndrome (HPS) is characterized by a defect in arterial oxygenation that's induced by pulmonary vascular dilatation in the setting of liver disease. Some studies have shown the relationship between the presence of the HPS and the severity of liver disease, but there are only rare cases of HPS inpatient with Child-Pugh class A liver cirrhosis. We report here on a case of a 58 years-old male who suffered from progressive dyspnea for the previous few years. He was diagnosed with alcoholic liver cirrhosis 5 years previously. There was no significant abnormality on the chest radiograph and transthoracic echocardiography, but the arterial blood gas analysis revealed severe hypoxemia. Contrast-enhanced transesophageal echocardiograpy with agitated saline demonstrated a delayed appearance of microbubbles in the left cardiac chambers. Thus, he was finally diagnosed with HPS. This case suggests that we should consider HPS when a patient with compensated liver cirrhosis has unexplained dyspnea.

간폐증후군은 간질환이 있는 환자에서 저산소증이 유발되는 상태로 폐내 혈관 확장으로 인해 폐내 동맥혈 산소공급에 결함이 발생하는 질환이다. 현재까지 간이식 외에 간폐증후군에 대한 다른 효과적인 치료법은 없는 것으로 알려져 있다. 국내에서는 간폐증후군의 증례 보고가 드물고, 특히 Child-Pugh 분류 A군에서의 발생 빈도는 낮은 것으로 보인다. 이에 저자들은 Child-Pugh 분류 A군인 대상성 간경화 환자에서 발생한 간폐증후군 1예를 경험하여 문헌 고찰과 함께 보고하는 바이다.

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References

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