Hepatopulmonary Syndrome Mimics Pulmonary Embolism on Pulmonary Ventilation/Perfusion SPECT/CT Study

A 64-year-old woman with a history of cirrhosis and progressive difficulty breathing underwent pulmonary ventilation/perfusion SPECT to evaluate possible pulmonary embolism. The images demonstrated multiple mismatched ventilation/perfusion defects in both lungs, suggesting pulmonary embolism. However, there was also 99mTc-MAA radioactivity in the brain and bilateral kidney, with a right-to-left shunting rate of 8.8%. In addition, CT pulmonary angiography did not demonstrate embolus. The findings indicated that perfusion defects were caused by hepatopulmonary syndrome.
Source: Clinical Nuclear Medicine - Category: Nuclear Medicine Tags: Interesting Images Source Type: research

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Semin Thromb Hemost DOI: 10.1055/s-0039-1697682Patients with cirrhosis are not only at an increased risk of bleeding but also at risk of venous thromboembolism (VTE). We sought to determine the clinical characteristics, management, and outcomes after VTE in patients with cirrhosis. We used the data from RIETE (Registro Informatizado de la Enfermedad TromboEmbolica), an international registry of patients with VTE, to compare the outcomes in patients with and without cirrhosis. Main outcomes included all-cause mortality, pulmonary embolism (PE)-related mortality, recurrent VTE, and bleeding. Among 43,611 patients with acute ...
Source: Seminars in Thrombosis and Hemostasis - Category: Hematology Authors: Tags: Review Article Source Type: research
TheQJM has highlighted in recent articles the complications of end-stage liver disease.1 –3 Now, we address the clinically relevant question of whether direct oral anticoagulants (DOACs) are safe and effective in patients with cirrhosis. These patients are at significantly enhanced risk of thrombosis, be it a deep venous thrombosis or pulmonary embolism. Historically these patients were treated with vitamin K antagonists such as warfarin or low molecular weight heparin. These therapeutic modalities are associated with the requirement for monitoring, interactions with food or drugs and narrow therapeutic window.
Source: QJM - Category: Internal Medicine Source Type: research
CONCLUSION: Our study demonstrated a significantly increased risk of VTE among HCV-infected patients. Further studies are required to clarify how this risk should be addressed in clinical practice. PMID: 31208543 [PubMed]
Source: Annals of Hepatology - Category: Gastroenterology Tags: Ann Hepatol Source Type: research
Conclusion TIPS combined with antegrade embolization is safe, effective, and feasible for patients with SPSSs, with safety and long-term outcomes comparable to patients without SPSSs.
Source: European Journal of Gastroenterology and Hepatology - Category: Gastroenterology Tags: Original Articles: Hepatology Source Type: research
Conclusions: The LSEGDS is a safe and effective procedure for management of cirrhotic portal hypertension, especially in patients with visible paraesophageal veins. PMID: 31118982 [PubMed]
Source: Videosurgery and Other Miniinvasive Techniques - Category: Surgery Tags: Wideochir Inne Tech Maloinwazyjne Source Type: research
Today, we received two 3rd year medical students starting their IM rotation. I told them I would give them a list of podcasts that should help them get oriented to internal medicine. This is my podcast v1.0 list: From the Curbsiders: 142 Cirrhosis TIPS for Acute Complications 104: Renal tubular acidosis with Kidney Boy, Joel Topf MD 92: Pulmonary Embolism for the Internist 86: COPD: Diagnosis, treatment, PFTs, and nihilism 76: Pneumonia Pearls with Dr Robert Centor 61: Vasculitis and Giant-Cell Arteritis: ‘Rheum’ for improvement 52: Anemia: Tips, and tools for diagnosis and treatment ...
Source: DB's Medical Rants - Category: Internal Medicine Authors: Tags: Medical Rants Source Type: blogs
This article aims to review the latest literature on prophylactic and therapeutic anticoagulation and the safety profile of anticoagulants in patients with cirrhosis. Recent findings The understanding of hematological hemostasis is cirrhotic patients has changed drastically in recent years. Although in the past, cirrhotic patients were often considered to be ‘auto-anticoagulated’ and at higher risk of bleeding, recent studies have demonstrated that there may be a rebalance in procoagulation and anticoagulation factors in patients with cirrhosis. This, and clinical experience, suggest that cirrhotic patients ...
Source: Current Opinion in Gastroenterology - Category: Gastroenterology Tags: LIVER: Edited by Don C. Rockey Source Type: research
This Medicine MCQ Test Series contains 20 questions which can be attempted over 40 seconds each. After submission, answers and discussion will be displayed. Medicine MCQ Test Series 1 Time limit: 0 Quiz-summary 0 of 20 questions completed Questions: 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 Information ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Medicine MCQ - CVS Source Type: blogs
With great interest we have read the outstanding Grand Rounds article by Dhar et al., published recently in the Journal of Hepatology.1 In their article, the authors describe a patient with decompensated liver cirrhosis who experienced a fatal pulmonary embolism, which may have been prevented by prophylactic anticoagulation measures. Dhar and colleagues describe nicely that patients with advanced liver diseases are not only burdened with the well-recognized increased risk of bleeding events, but also with a substantial risk of thromboembolic complications.
Source: Journal of Hepatology - Category: Gastroenterology Authors: Tags: Letter to the Editor Source Type: research
Conclusion:In the community practice, aspirin (81mg or 325mg) is prescribed for cardio-protection. A recently concluded trial showed a better cardioprotective effect of combining rivaroxaban and aspirin, without increase in BE in patients with stable cardiovascular disease. However, such data is not evident in patients receiving rivaroxaban for DVT/PE. Our study shows an increased rate of bleeding events in such patients with concurrent use of aspirin. Our study population comprises of two-third African-American patients who are under-represented in the clinical trials. Based on our results we would suggest further investi...
Source: Blood - Category: Hematology Authors: Tags: 332. Antithrombotic Therapy Source Type: research
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