Hepatopulmonary syndrome diagnostic study of choice: Difference between revisions

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Revision as of 16:24, 31 July 2019

**Hepatopulmonary syndrome diagnostic triad.** Diagram by Soroush Seifirad, MD.

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Soroush Seifirad, M.D.[2]

Overview

There is no single diagnostic study of choice for the diagnosis of hepatopulmonary syndrome, but hepatopulmonary syndrome can be diagnosed based on history of liver disease, atrial blood gas analysis (widened alveolar-arterial oxygen gradient measurement); and evidences of intra-pulmonary vascular dilation or arterio-venous communications that result in a right-to-left intrapulmonary shunt.

Diagnostic Study of Choice

Study of choice

There is no single diagnostic study of choice for the diagnosis of hepatopulmonary syndrome, but hepatopulmonary syndrome can be diagnosed based on history of liver disease, atrial blood gas analysis (widened alveolar-arterial oxygen gradient measurement); and evidences of intra-pulmonary vascular dilation or arterio-venous communications that result in a right-to-left intrapulmonary shunt.

Investigations:

Among the patients who present with clinical signs of hepatopulmonary syndrome, the contrast-enhanced transthoracic echocardiography with agitated saline is the most specific test for the diagnosis.
Among the patients who present with clinical signs of hepatopulmonary syndrome, the atrial blood gas analysis is the most sensitive test for diagnosis.

Diagnostic results

The following findings are confirmatory for hepatopulmonary syndrome: (discussed in details)

Presence of bubbles on the left heart in contrast-enhanced transthoracic echocardiography with agitated saline
Presence of radioactivity on the left heart in Technetium 99m-labeled macroaggregated albumin scanning
Diffusion defect in atrial blood gas analysis particularly studying
Abnormal liver function studies
Abnormal pulmonary function test

References

Template:WH Template:WS

@@ Line 12: / Line 12: @@
-=== Study of choice ===
+Study of choice
-There is no single diagnostic study of choice for the diagnosis of hepatopulmonary syndrome, but hepatopulmonary syndrome can be diagnosed based on history of '''liver disease''',  atrial blood gas analysis (widened '''alveolar-arterial oxygen gradient''' measurement); and evidences of '''intra-pulmonary vascular dilation''' or arterio-venous communications that result in a '''right-to-left intrapulmonary shunt.'''
-Investigations:
-* Among the patients who present with clinical signs of hepatopulmonary syndrome, the [investigation name] is the most specific test for the diagnosis.
-* Among the patients who present with clinical signs of hepatopulmonary syndrome, the [investigation name] is the most sensitive test for diagnosis.
-* Among the patients who present with clinical signs of hepatopulmonary syndrome, the [investigation name] is the most efficient test for diagnosis.
-==== The comparison of various diagnostic studies for hepatopulmonary syndrome ====
+There is no single diagnostic study of choice for the diagnosis of hepatopulmonary syndrome, but hepatopulmonary syndrome can be diagnosed based on history of '''liver disease''',  atrial blood gas analysis (widened '''alveolar-arterial oxygen gradient''' measurement); and evidences of '''intra-pulmonary vascular dilation''' or arterio-venous communications that result in a '''right-to-left intrapulmonary shunt.'''
-{|
-|- style="background: #4479BA; color: #FFFFFF; text-align: center;"
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" | Test
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Sensitivity
-! style="background: #4479BA; color: #FFFFFF; text-align: center;" |Specificity
-|-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 1
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
-|-
-! style="background: #696969; color: #FFFFFF; text-align: center;" |Test 2
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
-| style="background: #DCDCDC; padding: 5px; text-align: center;" |...%
-|}
-<small> [Name of test with higher sensitivity and specificity] is the preferred investigation based on the sensitivity and specificity</small>
-===== Diagnostic results =====
-The following finding(s) on performing [investigation name] is(are) confirmatory for hepatopulmonary syndrome:
-* [Finding 1]
-* [Finding 2]
-===== Sequence of Diagnostic Studies =====
+'''Investigations:'''
-The [name of investigation] must be performed when:
-* The patient presented with symptoms/signs 1, 2, and 3 as the first step of diagnosis.
-* A positive [test] is detected in the patient, to confirm the diagnosis.
-OR
+* Among the patients who present with clinical signs of hepatopulmonary syndrome, the [[Hepatopulmonary syndrome echocardiography and ultrasound|'''contrast-enhanced transthoracic echocardiography with agitated saline''']] is the most specific test for the diagnosis.
+* Among the patients who present with clinical signs of hepatopulmonary syndrome, the [[Hepatopulmonary syndrome laboratory findings|'''atrial blood gas analysis''']] is the most sensitive test for diagnosis.
-The various investigations must be performed in the following order:
+<br />
-* [Initial investigation]
-* [2nd investigation]
-=== Name of Diagnostic Criteria ===
+===== Diagnostic results =====
+The following findings are confirmatory for hepatopulmonary syndrome: (discussed in details)
-'''It is recommended that you include the criteria in a table. Make sure you always cite the source of the content and whether the table has been adapted from another source.'''
+* Presence of bubbles on the left heart in contrast-enhanced transthoracic echocardiography with agitated saline
+* Presence of radioactivity on the left heart in Technetium 99m-labeled macroaggregated albumin scanning
-hepatopulmonary syndrome is primarily diagnosed based on clinical presentation. There are no established criteria for the diagnosis of hepatopulmonary syndrome.
+*Diffusion defect in atrial blood gas analysis particularly studying
+*Abnormal liver function studies
-OR
+*Abnormal pulmonary function test
-There is no single diagnostic study of choice for hepatopulmonary syndrome, though hepatopulmonary syndrome may be diagnosed based on [name of criteria] established by [...].
-OR
-The diagnosis of hepatopulmonary syndrome is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-OR
-The diagnosis of hepatopulmonary syndrome is based on the [criteria name] criteria, which includes [criterion 1], [criterion 2], and [criterion 3].
-OR
-hepatopulmonary syndrome may be diagnosed at any time if one or more of the following criteria are met:
-* Criteria 1
-* Criteria 2
-* Criteria 3
-OR
-'''IF there are clear, established diagnostic criteria'''
-The diagnosis of hepatopulmonary syndrome is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].
-OR
-The diagnosis of hepatopulmonary syndrome is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
-OR
-The diagnosis of hepatopulmonary syndrome is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
-OR
-'''IF there are no established diagnostic criteria'''
-There are no established criteria for the diagnosis of hepatopulmonary syndrome.
+<br />
 ==References==