Hepatopulmonary Syndrome with Right-to-left Shunt in Cirrhotic Patients Using Macro-Aggregated Albumin Lung Perfusion Scan: Comparison with Contrast Echocardiography and Association with Clinical Data

The diagnosis of hepatopulmonary syndrome (HPS) which is a common complication in cirrhotic patients is still subject to debate. This study investigated the association of clinical findings with HPS in cirrhotic patients using macro-aggregated albumin lung perfusion scan (99mTc-MAA lung scintigraphy). In addition, comparison between 99mTc-MAA lung scintigraphy and contrast echocardiography (CEE) in detection of HPS was also performed.Methods: In this study, 27 patients with cirrhosis underwent 99mTc-MAA lung scintigraphy and contrast echocardiography comparison CEE and the frequency of HPS was assessed in them and also was compared across the other variables.Results: The 99mTc-MAA lung scintigraphy showed HPS in 13 patients (48.1%) while CEE demonstrated HPS in 5 patients with cirrhosis (18.51%). HPS was mild in 40.74% (11/27) of the patients, and severe in only 2 patients. There was no relationship between gender, disease duration, having diagnosis of disease previously, pulmonary symptoms and Child-Pugh score variations and HPS (p>0.05). Comparison of hemodynamic indices, arterial blood gas analysis and laboratory indices between patients with and without HPS was also non-significant (p value >0.05). Among coagulation factors assessed in cirrhotic patients, we found only significant correlation between HPS and prothrombin time (p<0.05). Conclusion: HPS, particularly its mild form, is noted in a great number of patients with cirrhosis using 99mTc-MAA lung scintigraphy. Because of its technical ease, and possibility to obtain objective quantitative information, 99mTc-MAA lung scintigraphy can be complementary to other diagnostic methods in the evaluation of HPS assessment, although additional studies are needed.