DR Medhat MRCP

- In upright position→ ↑ blood flow to the dilated vessels at the lung bases→ ↑
ventilation-perfusion mismatch.
• C/P :
Asymptomatic (most of the patients).
Platypnoea & orthodeoxia
Desaturation during sleep.
Cyanosis.
Clubbing fingers
• Investigations :
Contrast echocardiography :
‏.سؤال - It`s the test of choice
- It → Detect intrapulmonary vascular dilatation.
→ Exclude intracardiac shunting which gives the same C/P.
- I.V agitated saline during TTE →
o Normally : microbubbles in right ventricles within
seconds→absorbed to the alveoli.
o Delayed visualization in LV (within 3 cardiac cycle) is diagnostic for
intrapulmonary shunting.
V-Q scan : can be used.
Sitting ABG.
CXR : normal.
• Treatment : liver transplantation .
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