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First presentation of portal hypertension complicated by hepatopulmonary syndrome
  1. Nahima Miah1,
  2. Aidan Ryan1,
  3. Ceyhun Aksel Oztumer2 and
  4. Mohamed Saleh3
  1. 1General Medicine, Medway Maritime Hospital, Gillingham, UK
  2. 2Medicine, Brighton and Sussex Medical School, Brighton, UK
  3. 3Gastroenterology and Hepatology, Medway Maritime Hospital, Gillingham, UK
  1. Correspondence to Dr Nahima Miah; nahima.miah{at}


Hepatopulmonary syndrome (HPS) is a serious complication of chronic liver disease, characterised by portal hypertension and arterial hypoxaemia due to intrapulmonary vascular dilatation. We report an unusual case in which a 27-year-old man had a first presentation of portal hypertension and cirrhosis complicated by HPS. This patient presented with progressive dyspnoea on exertion and deterioration in mobility, with a type 1 respiratory failure and increased oxygen demand. A bubble echocardiogram showed a possible right-to-left shunt, CT aortogram displayed evidence of portal hypertension and cirrhosis, and liver biopsy findings were consistent with alpha-1 antitrypsin deficiency. The patient’s increased oxygen demand was subsequently treated with continuous positive airway pressure before he was discharged with 8 L home oxygen. With no current established medical therapy for HPS, the patient was assessed for liver transplantation and a decision was made in favour of this.

  • portal hypertension
  • pulmonary hypertension

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  • Contributors All authors contributed to the design of the article and analysis of the results. NM, AR and CAO drafted the manuscript. MS revised the manuscript content for important intellectual content. All authors approved the final version of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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