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An Unusual Case of Refractory Hypoxia on the ICU

We present the case of a 68-year-old gentleman who presented with breathlessness and was found to have NSTEMI, pulmonary oedema, and hypoxia. He remained hypoxic despite appropriate treatment and was found to have preserved LV function and raised cardiac output. CT pulmonary angiogram was negative b...

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Detalles Bibliográficos
Autores principales: Phillips, Caroline, Harris, Clare, Broughton, Nathaniel, Pulimood, Thomas, Ring, Liam
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Hindawi 2018
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932523/
https://www.ncbi.nlm.nih.gov/pubmed/29850271
http://dx.doi.org/10.1155/2018/3417259
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author Phillips, Caroline
Harris, Clare
Broughton, Nathaniel
Pulimood, Thomas
Ring, Liam
author_facet Phillips, Caroline
Harris, Clare
Broughton, Nathaniel
Pulimood, Thomas
Ring, Liam
author_sort Phillips, Caroline
collection PubMed
description We present the case of a 68-year-old gentleman who presented with breathlessness and was found to have NSTEMI, pulmonary oedema, and hypoxia. He remained hypoxic despite appropriate treatment and was found to have preserved LV function and raised cardiac output. CT pulmonary angiogram was negative but a cirrhotic liver was incidentally noted and later confirmed via ultrasound. Bedside examination was positive for orthodeoxia, suggesting a diagnosis of hepatopulmonary syndrome (HPS). The finding of significant intrapulmonary shunting on “bubble” echocardiography confirmed the diagnosis. This patient did not have previously diagnosed liver disease and had largely normal LFTs when the diagnosis was first suspected. We discuss HPS in the context of ICU and suggest how it may be screened for using simple tests. There is no correlation between the presence of HPS and severity of liver disease, yet we believe this is the first reported adult case of HPS on the ICU without previously diagnosed cirrhosis.
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spelling pubmed-59325232018-05-30 An Unusual Case of Refractory Hypoxia on the ICU Phillips, Caroline Harris, Clare Broughton, Nathaniel Pulimood, Thomas Ring, Liam Case Rep Crit Care Case Report We present the case of a 68-year-old gentleman who presented with breathlessness and was found to have NSTEMI, pulmonary oedema, and hypoxia. He remained hypoxic despite appropriate treatment and was found to have preserved LV function and raised cardiac output. CT pulmonary angiogram was negative but a cirrhotic liver was incidentally noted and later confirmed via ultrasound. Bedside examination was positive for orthodeoxia, suggesting a diagnosis of hepatopulmonary syndrome (HPS). The finding of significant intrapulmonary shunting on “bubble” echocardiography confirmed the diagnosis. This patient did not have previously diagnosed liver disease and had largely normal LFTs when the diagnosis was first suspected. We discuss HPS in the context of ICU and suggest how it may be screened for using simple tests. There is no correlation between the presence of HPS and severity of liver disease, yet we believe this is the first reported adult case of HPS on the ICU without previously diagnosed cirrhosis. Hindawi 2018-04-17 /pmc/articles/PMC5932523/ /pubmed/29850271 http://dx.doi.org/10.1155/2018/3417259 Text en Copyright © 2018 Caroline Phillips et al. https://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Case Report
Phillips, Caroline
Harris, Clare
Broughton, Nathaniel
Pulimood, Thomas
Ring, Liam
An Unusual Case of Refractory Hypoxia on the ICU
title An Unusual Case of Refractory Hypoxia on the ICU
title_full An Unusual Case of Refractory Hypoxia on the ICU
title_fullStr An Unusual Case of Refractory Hypoxia on the ICU
title_full_unstemmed An Unusual Case of Refractory Hypoxia on the ICU
title_short An Unusual Case of Refractory Hypoxia on the ICU
title_sort unusual case of refractory hypoxia on the icu
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5932523/
https://www.ncbi.nlm.nih.gov/pubmed/29850271
http://dx.doi.org/10.1155/2018/3417259
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