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간경변 환자에서 조영 심초음파검사를 이용한 폐내 단락의 빈도 및 임상적 의의
정석(Seok Jeong),배성권(Sung Kwon Bae),권계숙(Kye Sook Kwon),조성욱(Seong Wook Cho),고광근(Kwang Kon Koh),신용운(Yong Woon Shin),조상균(Sang Kyoon Cho),김순혜(Soon Hye Kim),김삼수(Sam Soo Kim) 대한내과학회 1998 대한내과학회지 Vol.54 No.5
Objectives: Intrapulmonary vascular abnormalities resulting in right-to-left shunt have been described in patients with severe liver disease, especially advanced hepatic cirrhosis. They result in hypoxemia which is associated with liver cirrhosis without preexisting cardiac or pulmonary diseases. Since Rydell and Hoffbauer first described intrapulmonary shunt in a cirrhotic patient in 1956, it has been reported recently that 13 to 47 percent of the end-stage hepatic disease patients have these intrapulmonary vascular abnormalities. Contrast echocardiography (CE) has been proved useful in detecting intrapulmonary shunt, The aim of the study is to determine the prevalence of intrapulmonary shunt by CE in patients with hepatic cirrhosis, and to campare the clinical characteristics of those with and without evidence of intrapulmonary shunt. Methods: We performed CE studies in 24 stable cirrhotic patients without the evidence of severe complications such as massive ascites, upper GI bleeding, and hepatic coma. Clinical information including symptom and sign, results of liver and pulmonary function tests, and arterial blood gas values measured both at the supine and erect position, were analyzed in each group of patients with or without intrapulmonary shunt. Results: Positive CE suggesting intrapulmonary shunt was found in 8 of 2A patients (33.3%). However the degree of relative opacifications were one positive (1+) in all 8 patients, and hypoxemia and its related symptom and sign appeared to be rare. Any of the parameters of liver and pulmonary function test did not show the significant difference between CE-positive and CE-negative group. Conclusion: Only the presence of spider angioma was associated with intrapulmonary shunt among the several clinical signs, which suggests common pathogenesis of both vascular abnormalities.