Hepatopulmonary syndrome: a prospective study of relationships between severity of liver disease, PaO(2) response to 100% oxygen, and brain uptake after (99m)Tc MAA lung scanning

Chest. 2000 Sep;118(3):615-24. doi: 10.1378/chest.118.3.615.


Background: Because of the spectrum of intrapulmonary vascular dilation that characterizes hepatopulmonary syndrome (HPS), PaO(2) while breathing 100% oxygen varies. Abnormal extrapulmonary uptake of (99m)Tc macroaggregated albumin (MAA) after lung perfusion is common.

Goal: To describe relationships between (1) severity of liver disease measured by the Child-Pugh (CP) classification; (2) PaO(2) while breathing room air (RA) and 100% oxygen on 100% oxygen; and (3) extrapulmonary (brain) uptake of (99m)Tc MAA after lung scanning.

Methods and patients: We prospectively measured PaO(2) on RA, PaO(2) on 100% oxygen, and brain uptake after lung perfusion of (99m)Tc MAA in 25 consecutive HPS patients.

Results: Mean PaO(2) on RA, PaO(2) on 100% oxygen, PaCO(2) on RA, and (99m)Tc MAA brain uptake were similar when categorized by CP classification. Brain uptake was abnormal (> or = 6%) in 24 patients (96%). Brain uptake was 29 +/- 20% (mean +/- SD) and correlated inversely with PaO(2) on RA (r = -0.57; p<0.05) and PaO(2) on 100% oxygen (r = -0.41; p<0.05). Seven patients (28%) had additional nonvascular pulmonary abnormalities and lower PaO(2) on 100% oxygen (215+/-133 mm Hg vs 391+/-137 mm Hg; p<0.007). Eight patients (32%) died. Mortality in patients without coexistent pulmonary abnormalities was associated with greater brain uptake of (99m)Tc MAA (48+/-18% vs 25+/-20%; p<0.04) and lower PaO(2) on RA (40+/-7 mm Hg vs 57+/-11 mm Hg; p<0.001).

Conclusion: The degree of hypoxemia associated with HPS was not related to the CP severity of liver disease. HPS patients with additional nonvascular pulmonary abnormalities exhibited lower PaO(2) on 100% oxygen. Mortality was associated with lower PaO(2) on RA, and with greater brain uptake of (99m)Tc MAA.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Angiography
  • Brain / metabolism*
  • Child
  • Female
  • Hepatopulmonary Syndrome / complications
  • Hepatopulmonary Syndrome / diagnosis*
  • Hepatopulmonary Syndrome / metabolism
  • Hepatopulmonary Syndrome / physiopathology
  • Humans
  • Hypoxia / diagnosis
  • Hypoxia / etiology
  • Hypoxia / metabolism
  • Lung / diagnostic imaging*
  • Lung / physiopathology
  • Male
  • Middle Aged
  • Oxygen / metabolism*
  • Prospective Studies
  • Radionuclide Imaging
  • Respiratory Function Tests
  • Severity of Illness Index
  • Sulfhydryl Compounds* / pharmacokinetics
  • Technetium Tc 99m Aggregated Albumin* / pharmacokinetics


  • Sulfhydryl Compounds
  • Technetium Tc 99m Aggregated Albumin
  • technetium Tc99m-mercaptoacetyl albumin
  • Oxygen