AN INTERESTING CASE OF HEPATOPULMONARY SYNDROME

Here we report a case of 15 year old male presented with recurrent episodes of upper GI Bleed with dyspnea on sitting past history of jaundice on examination Moderately built, nourished, central cyanosis pandigital clubbing, no pedal edema, no lymphadenopathy, spider naevi , no jaundice Systemic examination Examination of AbdomenLivspan10cmsSplenomegaly, no free fluidCVS S1S2 heard no murmurRS NVBS no added sounds CBC HB 19.8 gmsdl PCV 60.5 T.B 0.8mgdl SGOT 32 IU SGPT 45 IU T.P 6.3gmsdl USG ABD Doppler Both lobes of Liver small 8.8cms portal vein -13mm no respiration variations splenic vein 7.6 mm splenorenal collaterals UGIE Esophageal varices Grade 1-11 columns , PHTG Arterial blood gas Analysis PH 7.47 Pco2 24.5 Pao2 48 Sao2 81.3 Na 141 K 3.7 Hco3 52 CECT chest normal ECHO Situs Levocardia ,Normal AVVA concordance Septum intact, mPAP 17 mmhg no PHT, normal LV function ContrastEchocardiogram Peripheral intravenous injection of agitated saline to produce micro bubbles(10-15micron) appeared in Left ventricle Delayed after 3 to 6 beats suggestive of intrapulmonary shunting