SELF-ASSESSMENT QUESTIONS
A case of refractory hypoxaemia
1 Scottish Pulmonary Vascular Unit, Western Infirmary, Glasgow, UK
2 Respiratory Medicine, Department of Medicine, University of Cambridge, Addenbrookes Hospital, Cambridge, UK
Correspondence to:
Dr A C Church, Scottish Pulmonary Vascular Unit, Western Infirmary, Dumbarton Road, Glasgow, G11 6NT, UK; colinchurch@doctors.org.uk
Accepted 7 July 2008
Keywords: hepatopulmonary syndrome; pulmonary arteriovenous shunts; orthodeoxia
| The first 150 words of the full text of this article appear below. |
A 61-year-old man, who is a lifelong non-smoker, was found on routine testing in 2002 to have abnormal liver function tests. Ultrasound examination demonstrated abnormal liver texture. Shortly afterwards he had a significant bleed from an oesophageal varicoele and as a consequence underwent computed tomography (CT) scanning of his thorax and abdomen. A liver biopsy was performed at this time, which showed granulomatous hepatitis. On the basis of this and widespread hilar and mediastinal lymphadenopathy, a clinical diagnosis of sarcoidosis was made. Treatment with systemic corticosteroids resulted in a modest improvement in his liver function and general well being.
Over the subsequent 4 years he developed finger clubbing and progressive exertional dyspnoea with a final exercise tolerance of just 20 m on the flat. He was aware that his dyspnoea improved when lying down. Clinical examination at this time revealed cyanosis, an elevated jugular venous pressure, and a degree of
CiteULike 
Complore 
Connotea 
Del.icio.us 
Digg 
Reddit 
Technorati What's this?
- Full Text
- Full Text (PDF)
- Submit a response
- Alert me when this article is cited
- Alert me when eLetters are posted
- Alert me if a correction is posted
- Citation Map
Services
- Email this link to a friend
- Similar articles in this journal
- Similar articles in PubMed
- Add article to my folders
- Download to citation manager
- Request Permissions
Citing Articles
Google Scholar
PubMed
Bookmark with
Register for free content
The full back archive is now available for all BMJ Journals. Institutional subscribers may access the entire archive as part of their subscription. Personal subscribers will also have access to all content when logged in. Non-subscribers who register have free access to all articles published before 2006 right back to volume 1 issue 1. Register here to access the free archive of all BMJ Journals.
Don't forget to sign up for content alerts so you keep up to date with all the articles as they are published.
