An Unusual Case of Refractory Hypoxia on the ICU
We present the case of a 68-year-old gentleman who presented with breathlessness and was found to have NSTEMI, pulmonary oedema, and hypoxia. He remained hypoxic despite appropriate treatment and was found to have preserved LV function and raised cardiac output. CT pulmonary angiogram was negative b...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Case Reports in Critical Care |
| Online Access: | http://dx.doi.org/10.1155/2018/3417259 |
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| _version_ | 1849399159994449920 |
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| author | Caroline Phillips Clare Harris Nathaniel Broughton Thomas Pulimood Liam Ring |
| author_facet | Caroline Phillips Clare Harris Nathaniel Broughton Thomas Pulimood Liam Ring |
| author_sort | Caroline Phillips |
| collection | DOAJ |
| description | We present the case of a 68-year-old gentleman who presented with breathlessness and was found to have NSTEMI, pulmonary oedema, and hypoxia. He remained hypoxic despite appropriate treatment and was found to have preserved LV function and raised cardiac output. CT pulmonary angiogram was negative but a cirrhotic liver was incidentally noted and later confirmed via ultrasound. Bedside examination was positive for orthodeoxia, suggesting a diagnosis of hepatopulmonary syndrome (HPS). The finding of significant intrapulmonary shunting on “bubble” echocardiography confirmed the diagnosis. This patient did not have previously diagnosed liver disease and had largely normal LFTs when the diagnosis was first suspected. We discuss HPS in the context of ICU and suggest how it may be screened for using simple tests. There is no correlation between the presence of HPS and severity of liver disease, yet we believe this is the first reported adult case of HPS on the ICU without previously diagnosed cirrhosis. |
| format | Article |
| id | doaj-art-a3e86b1c2d0b4324944f4d3fbe03cc7b |
| institution | Kabale University |
| issn | 2090-6420 2090-6439 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Critical Care |
| spelling | doaj-art-a3e86b1c2d0b4324944f4d3fbe03cc7b2025-08-20T03:38:24ZengWileyCase Reports in Critical Care2090-64202090-64392018-01-01201810.1155/2018/34172593417259An Unusual Case of Refractory Hypoxia on the ICUCaroline Phillips0Clare Harris1Nathaniel Broughton2Thomas Pulimood3Liam Ring4Department of Anaesthesia and Critical Care, West Suffolk NHS Foundation Trust, Bury St Edmunds, UKDepartment of Respiratory Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, UKDepartment of Anaesthesia and Critical Care, West Suffolk NHS Foundation Trust, Bury St Edmunds, UKDepartment of Respiratory Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, UKDepartment of Cardiology, West Suffolk NHS Foundation Trust, Bury St Edmunds, UKWe present the case of a 68-year-old gentleman who presented with breathlessness and was found to have NSTEMI, pulmonary oedema, and hypoxia. He remained hypoxic despite appropriate treatment and was found to have preserved LV function and raised cardiac output. CT pulmonary angiogram was negative but a cirrhotic liver was incidentally noted and later confirmed via ultrasound. Bedside examination was positive for orthodeoxia, suggesting a diagnosis of hepatopulmonary syndrome (HPS). The finding of significant intrapulmonary shunting on “bubble” echocardiography confirmed the diagnosis. This patient did not have previously diagnosed liver disease and had largely normal LFTs when the diagnosis was first suspected. We discuss HPS in the context of ICU and suggest how it may be screened for using simple tests. There is no correlation between the presence of HPS and severity of liver disease, yet we believe this is the first reported adult case of HPS on the ICU without previously diagnosed cirrhosis.http://dx.doi.org/10.1155/2018/3417259 |
| spellingShingle | Caroline Phillips Clare Harris Nathaniel Broughton Thomas Pulimood Liam Ring An Unusual Case of Refractory Hypoxia on the ICU Case Reports in Critical Care |
| title | An Unusual Case of Refractory Hypoxia on the ICU |
| title_full | An Unusual Case of Refractory Hypoxia on the ICU |
| title_fullStr | An Unusual Case of Refractory Hypoxia on the ICU |
| title_full_unstemmed | An Unusual Case of Refractory Hypoxia on the ICU |
| title_short | An Unusual Case of Refractory Hypoxia on the ICU |
| title_sort | unusual case of refractory hypoxia on the icu |
| url | http://dx.doi.org/10.1155/2018/3417259 |
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