An Unusual Case of Dyspnoea in a Patient with Chronic Liver Disease

Both portopulmonary hypertension and hepatopulmonary syndrome are relatively uncommon causes of dyspnoea, but should be considered in patients with portal hypertension in whom other common causes have been excluded. This case study highlights these alternative causes of dyspnoea in patients with chronic liver disease. A 58 year old male with known alcoholic cirrhosis presented with increasing dyspnoea and abdominal swelling. His shortness of breath persisted despite large volume paracentesis. His blood gas revealed a severe hypoxia and a transthoracic echocardiogram showed a severely elevated pulmonary artery systolic pressure. Right heart catheterisation confirmed severe pulmonary hypertension. Liver transplantation was contraindicated due to the severity of the pulmonary hypertension therefore medical treatment was focussed on symptom control. He was started on sildenafil 25 mg three times daily and the patient reported some improvement in symptoms after 3 months of treatment.