{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,28]],"date-time":"2026-01-28T02:57:13Z","timestamp":1769569033627,"version":"3.49.0"},"reference-count":6,"publisher":"BMJ","issue":"1","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,1,7]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>Hepatopulmonary syndrome (HPS) is an under-recognised complication of chronic liver disease, affecting 10%\u201330% of patients with cirrhosis. It involves intrapulmonary vascular dilatations, arterial hypoxaemia and an elevated alveolar\u2013arterial gradient, causing impaired functional status and increased peri-transplant morbidity. Early recognition is crucial for timely liver transplantation referral.<\/jats:p>\n                  <jats:p>We report a woman in her mid-50s with alcohol-related liver disease admitted for a urinary tract infection, in whom severe exertional hypoxaemia was incidentally revealed. She developed positional dyspnoea and marked desaturation on the 6-min walk test (6MWT). Arterial blood gas confirmed hypoxaemia with an elevated alveolar\u2013arterial gradient. DLCO was reduced, and contrast transthoracic echocardiography confirmed intrapulmonary shunting; other causes of hypoxaemia were excluded by relevant investigations.<\/jats:p>\n                  <jats:p>She was referred for transplant assessment; however, ongoing alcohol use precluded listing. Symptomatic treatment was initiated. This case underscores the 6MWT and posture assessment in unmasking HPS and informing appropriate clinical decision-making, without implying therapeutic impact.<\/jats:p>","DOI":"10.1136\/bcr-2025-269161","type":"journal-article","created":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:45:17Z","timestamp":1769517917000},"page":"e269161","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Unmasking hepatopulmonary syndrome: the 6-min walk test as a key to a missed diagnosis"],"prefix":"10.1136","volume":"19","author":[{"given":"Muhammad Kazim","family":"Bashir","sequence":"first","affiliation":[{"name":"Stroke and Geriatric Medicine, Letterkenny University Hospital, Letterkenny, Donegal, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hemnaath","family":"Ulaganathan","sequence":"additional","affiliation":[{"name":"Stroke and Geriatric Medicine, Letterkenny University Hospital, Letterkenny, Donegal, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jose","family":"Miranda","sequence":"additional","affiliation":[{"name":"Stroke and Geriatric Medicine, Letterkenny University Hospital, Letterkenny, Donegal, Ireland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2026,1,27]]},"reference":[{"key":"2026012704450988000_19.1.e269161.1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0000000000001229"},{"key":"2026012704450988000_19.1.e269161.2","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.rmed.2017.05.016","article-title":"The multiple dimensions of Platypnea-Orthodeoxia syndrome: A review","volume":"129","author":"Agrawal","year":"2017","journal-title":"Respir Med"},{"key":"2026012704450988000_19.1.e269161.3","unstructured":"OPTN\/UNOS . MELD\/PELD exception guidance: Hepatopulmonary syndrom. OPTN\/UNOS; 2025."},{"key":"2026012704450988000_19.1.e269161.4","first-page":"11340781","article-title":"Hepatopulmonary Syndrome: A Comprehensive Review","volume":"11","author":"Qasim","year":"2024","journal-title":"Front Med (Lausanne)"},{"key":"2026012704450988000_19.1.e269161.5","doi-asserted-by":"crossref","first-page":"485","DOI":"10.1097\/ACO.0000000000001538","article-title":"Hepatopulmonary syndrome: pathophysiological mechanisms and clinical implications","volume":"38","author":"La Via","year":"2025","journal-title":"Curr Opin Anaesthesiol"},{"key":"2026012704450988000_19.1.e269161.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhep.2018.03.024"}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269161","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,1,27]],"date-time":"2026-01-27T12:45:18Z","timestamp":1769517918000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269161"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,1]]},"references-count":6,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,1,27]]},"published-print":{"date-parts":[[2026,1]]}},"alternative-id":["10.1136\/bcr-2025-269161"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269161","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,1]]}}}