Evidence for an Association Between Intrahepatic Vascular Changes and the Development of Hepatopulmonary Syndrome.
Biopsy
Case-Control Studies
Female
Follow-Up Studies
Hepatic Artery
/ diagnostic imaging
Hepatopulmonary Syndrome
/ diagnosis
Humans
Hypertension, Pulmonary
/ complications
Liver
/ blood supply
Liver Circulation
/ physiology
Liver Cirrhosis
/ complications
Lung
/ diagnostic imaging
Male
Middle Aged
Multidetector Computed Tomography
Portal Vein
/ diagnostic imaging
Regional Blood Flow
/ physiology
Retrospective Studies
Ultrasonography, Doppler
angiogenesis
cirrhosis
hepatopulmonary syndrome
portal hypertension
thrombosis
Journal
Chest
ISSN: 1931-3543
Titre abrégé: Chest
Pays: United States
ID NLM: 0231335
Informations de publication
Date de publication:
01 2019
01 2019
Historique:
received:
13
05
2018
revised:
21
08
2018
accepted:
05
09
2018
pubmed:
8
10
2018
medline:
12
10
2019
entrez:
8
10
2018
Statut:
ppublish
Résumé
Hepatopulmonary syndrome (HPS) is characterized by an arterial oxygenation defect, defined by an increased alveolar-arterial oxygen gradient, induced by pulmonary vascular dilatations in the context of liver disease. The pathogenesis of HPS is poorly understood. Morphologic changes associated with HPS are unknown. This study aimed at describing imaging and pathology changes associated with HPS. We performed a case-control study in candidates for transplant with suspicion of cirrhosis. Each patient with HPS (Pao CT scans and Doppler ultrasounds from 21 patients with HPS were compared with those from 63 control subjects. HPS was associated with a two- to threefold higher prevalence of obstructed intrahepatic portal branches, of slowed or hepatofugal portal blood flow, and of large abdominal portosystemic shunts. Hepatic artery diameter was also larger in patients with HPS. Explanted livers from 19 patients with HPS were compared with those from 57 control subjects. HPS was associated with a fourfold higher prevalence of portal venule thrombosis and a ninefold higher prevalence of extensive vascular proliferation within fibrous septa. Obstruction of centrilobular venules, sinusoidal dilatation, and liver parenchymal extinction were also more common in patients with HPS. HPS is associated with intrahepatic vascular changes and with features suggesting severe portal hypertension. These results raise the hypothesis that intrahepatic vascular changes precipitate the development of HPS, opening new therapeutic perspectives for HPS.
Sections du résumé
BACKGROUND
Hepatopulmonary syndrome (HPS) is characterized by an arterial oxygenation defect, defined by an increased alveolar-arterial oxygen gradient, induced by pulmonary vascular dilatations in the context of liver disease. The pathogenesis of HPS is poorly understood. Morphologic changes associated with HPS are unknown. This study aimed at describing imaging and pathology changes associated with HPS.
METHODS
We performed a case-control study in candidates for transplant with suspicion of cirrhosis. Each patient with HPS (Pao
RESULTS
CT scans and Doppler ultrasounds from 21 patients with HPS were compared with those from 63 control subjects. HPS was associated with a two- to threefold higher prevalence of obstructed intrahepatic portal branches, of slowed or hepatofugal portal blood flow, and of large abdominal portosystemic shunts. Hepatic artery diameter was also larger in patients with HPS. Explanted livers from 19 patients with HPS were compared with those from 57 control subjects. HPS was associated with a fourfold higher prevalence of portal venule thrombosis and a ninefold higher prevalence of extensive vascular proliferation within fibrous septa. Obstruction of centrilobular venules, sinusoidal dilatation, and liver parenchymal extinction were also more common in patients with HPS.
CONCLUSIONS
HPS is associated with intrahepatic vascular changes and with features suggesting severe portal hypertension. These results raise the hypothesis that intrahepatic vascular changes precipitate the development of HPS, opening new therapeutic perspectives for HPS.
Identifiants
pubmed: 30292761
pii: S0012-3692(18)32500-5
doi: 10.1016/j.chest.2018.09.017
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
123-136Informations de copyright
Copyright © 2018 American College of Chest Physicians. Published by Elsevier Inc. All rights reserved.