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Volume 8, Issue 3(Suppl)

J Allergy Ther, an open access journal

ISSN: 2155-6121

Allergy-Clinical Immunology 2017

September 07-08, 2017

September 07-08, 2017 | Edinburgh, Scotland

ALLERGY, ASTHMA & CLINICAL IMMUNOLOGY

International Conference on

Hepatopulmonary syndrome (HPS)

Tahira Adnan

Allergy Respiratory Registrar, UK

Case Presentation summary:

55 year old gentleman, Married with three children, currently unemployed, normally fit and

well, Known Type 2 Diabetes Mellitus (on metformin) Pancytopenia with Macrocytosis(two Bone marrow biopsies. Reduced

Cellularity and bone marrow trephine was inadequate. HIV negative)Patient presented to Ealing Hospital on 9/9/16 with a dry

cough and increased shortness of breath, on a background of chronic progressive dyspnoea. CT Chest excluded pulmonary

embolism or significant pneumonic process. CT study of the abdomen showed moderate cirrhosis of the liver, with portal

hypertension and splenic and gastric varices. OGD confirmed oesophageal varices. The aetiology remains unclear; liver screen

showed normal autoantibodies, Heptititis screen negative along with negative gene for haemachromatosis in the past as per

Gastroenterology clinic letters.Ventilation perfusion studies of the lung showed evidence of a right to left shunt, although

could not determine cardiac or pulmonary origin.Subsequently he had an initial TOE which showed Normal RV size and

function with no evidence of cardiac shunt on Doppler studies.The TOE suggested the possibility of a right to left shunt but

the picture quality was suboptimal Patient had another review by cardiology Consultant who performed a contrast TTE on

12/12/2016 which confirms the presence of a Right to Left shunt with agitated gelofusine microbubbles appearing in the left

atrium 5 cardiac cycles after appearing in the right atrium. Cardiac MRI does not show evidence of a cardiac shunt and with

a Qp:Qs ration of <1.0 supports the possibility of a right to left

summary the above findings are compatible with

Pulmonary Right to Left shunt.Patient will be presented in the cardiac MDT and was given cofmirmed diagnosis of HPS

Patient was reviewed by the Gastroenterology team while in patient and discharged home with Home oxygen and referred to

Liver transplant unit king’s college London.

J Allergy Ther 2017, 8:3(Suppl)

DOI: 10.4172/2155-6121-C1-006