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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...
Autores principales: | , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Hindawi
2018
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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. |
format | Online Article Text |
id | pubmed-5932523 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2018 |
publisher | Hindawi |
record_format | MEDLINE/PubMed |
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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