Abstract

The hepatopulmonary syndrome is a rare lung complication of liver disease. When liver is not functioning properly, blood vessel in lung may dilate, if this is severe enough, the lungs can lose their ability to effectively transfer oxygen to the body. This is called as hepatopulmonary syndrome and it occurs in approximately 5-32%of patients with scarring of liver. The following case highlights complication of liver disease leading to pulmonary compromise, leading to hypoxemia in a known case of disseminated tuberculosis. Child had come with complains of fever and respiratory distress since 4 days. On examination child was cachexic, neck veins pulsatile, central cyanosis present ,pallor present , grade 3 clubbing present .Spo2- 62% on room air,CVS-s1s2+, grade 4 murmur with thrill, P/A- left of liver palpable 3cm below RCM, non tender, with sharp margins .Child was evaluated thouroughly, pulomonary angiography was done s/o small AV fistula .CECT abdo s/o liver parenchymal disease with dysplastic nodules with portal hypertension with narrowing of splenic artery aneurysm .The cause of chronic liver disease was a mystery until HIV had come out to be positive. Liver transplant of the patient was planned and child was discharged after explaining grave prognosis to the mother about the condition of child.

Keywords: Hepatopulmonary syndrome, hypoxemia, chronic liver disease, HIV.