ABSTRACT

Among the group of pleuropulmonary manifestations associated with hepatic insufficiency, the hepatopulmonary syndrome (HPS) is a well described entity. Nevertheless, there also exists another group of pleuropulmonary manifestations different from the HPS. In this article, a series of well defined disorders in which the portopulmonary circulation originates intrapulmonary vascular dilatations, leading to arteriovenous fistulas is described. The pulmonary hypertension associated with hepatic failure is produced by vasoconstriction secondary to the lack of inhibition of vasoconstriction mediators or a decreased production of vasodilating substances. The pleural effusion is a transudate, often bilaterally but with preference for the right hemithorax, and the postulated hypothesis is for hypertension of the portopulmonary circulation with the consequent permeability to the pleural cavity. The same mechanism produces an increment of the interstitial space, with the consistent alveolar occupation, which gives origin to pulmonary edema. The hypoxemia is not necessarily related to the HPS, and is assumed to be due to the decrease of the pulmonary expansion, and also the alveolar reexpansion. The diagnosis of these alterations is established on the basis of a clinical history and physical examination, the chest X-ray contributes to the diagnosis in the majority of the cases, and there is need of complementary studies, such as arterial blood gases and hepatic function test.

KEYWORDS

Lung, liver, hepatic failure.

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