{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,27]],"date-time":"2026-02-27T05:08:25Z","timestamp":1772168905068,"version":"3.50.1"},"update-to":[{"DOI":"10.12688\/f1000research.15434.1","type":"new_version","label":"New version","source":"publisher","updated":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T00:00:00Z","timestamp":1557964800000}}],"reference-count":24,"publisher":"F1000 Research Ltd","license":[{"start":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T00:00:00Z","timestamp":1557964800000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["f1000research.com"],"crossmark-restriction":false},"short-container-title":["F1000Res"],"abstract":"<ns4:p>An 86 year old woman with multiple chronic lung diseases (including chronic obstructive pulmonary disease, bronchiectasis, and untreated mycobacterium avium-intracellulare) presented with two weeks of increased shortness of breath, notably worse when seated as compared to when lying down. After treatments focused on her known conditions did not resolve her dyspnea, the differential diagnosis was broadened and she was found to have evidence of cirrhosis on imaging. As a result of this new diagnosis, transthoracic echocardiography and arterial blood gas analysis were performed and together yielded the diagnosis of hepatopulmonary syndrome. We describe a rare presentation of hepatopulmonary syndrome manifesting as a patient\u2019s first clinical evidence of suspected cirrhosis, a diagnosis made difficult by this patient\u2019s numerous other lung diseases which muddied the picture.<\/ns4:p>","DOI":"10.12688\/f1000research.15434.2","type":"journal-article","created":{"date-parts":[[2019,5,16]],"date-time":"2019-05-16T06:00:16Z","timestamp":1557986416000},"page":"1175","update-policy":"https:\/\/doi.org\/10.12688\/f1000research.crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Case Report: Hepatopulmonary syndrome as the first clinical manifestation of cirrhosis in a patient with underlying chronic lung disease"],"prefix":"10.12688","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7983-5160","authenticated-orcid":false,"given":"Charles","family":"Murphy","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Danit","family":"Arad","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2560","published-online":{"date-parts":[[2019,5,16]]},"reference":[{"key":"ref-1","doi-asserted-by":"publisher","first-page":"1035-1041","DOI":"10.2147\/VHRM.S3608","article-title":"Current concepts in the management of hepatopulmonary syndrome.","volume":"4","author":"V Ho","year":"2008","journal-title":"Vasc Health Risk Manag."},{"key":"ref-2","doi-asserted-by":"publisher","first-page":"1954-1956","DOI":"10.3748\/wjg.v12.i12.1954","article-title":"Clinical features of hepatopulmonary syndrome in cirrhotic patients.","volume":"12","author":"A Mohammad Alizadeh","year":"2006","journal-title":"World J Gastroenterol."},{"key":"ref-3","doi-asserted-by":"publisher","DOI":"10.1097\/MCG.0000000000000926","article-title":"Screening for Hepatopulmonary Syndrome in Cirrhotic Patients Using Technetium 99m-macroaggregated Albumin Perfusion Lung Scan (Tc-MAA): Diagnostic Approach and Clinical Correlations.","author":"M Fragaki","year":"2017","journal-title":"J Clin Gastroenterol."},{"key":"ref-4","doi-asserted-by":"publisher","first-page":"339-344","DOI":"10.5603\/ARM.2017.0058","article-title":"Dyspnoea, cyanosis and digital clubbing in a 28-year-old patient as a result of hepatopulmonary syndrome.","volume":"85","author":"M Zieli\u0144ski","year":"2017","journal-title":"Adv Respir Med."},{"key":"ref-5","doi-asserted-by":"publisher","first-page":"2378-2387","DOI":"10.1056\/NEJMra0707185","article-title":"Hepatopulmonary syndrome--a liver-induced lung vascular disorder.","volume":"358","author":"R Rodr\u00edguez-Roisin","year":"2008","journal-title":"N Engl J Med."},{"key":"ref-6","doi-asserted-by":"publisher","first-page":"711-729","DOI":"10.1002\/cphy.c170020","article-title":"Hepatopulmonary Disorders: Gas Exchange and Vascular Manifestations in Chronic Liver Disease.","volume":"8","author":"R Rodr\u00edguez-Roisin","year":"2018","journal-title":"Compr Physiol."},{"key":"ref-7","doi-asserted-by":"crossref","first-page":"354-60","DOI":"10.1016\/S1665-2681(19)31275-X","article-title":"Clinical characteristics, predictors, and survival among patients with hepatopulmonary syndrome.","volume":"14","author":"I Younis","year":"2015","journal-title":"Ann Hepatol."},{"key":"ref-8","doi-asserted-by":"publisher","first-page":"175-179","DOI":"10.1590\/S0004-28032013000200031","article-title":"Are the spider angiomas skin markers of hepatopulmonary syndrome?","volume":"50","author":"O Silv\u00e9rio Ade","year":"2013","journal-title":"Arq Gastroenterol."},{"key":"ref-9","doi-asserted-by":"publisher","first-page":"K25-K27","DOI":"10.1530\/ERP-14-0100","article-title":"A case of hepatopulmonary syndrome.","volume":"2","author":"J Offer","year":"2015","journal-title":"Echo Res Pract."},{"key":"ref-10","doi-asserted-by":"publisher","first-page":"861-80","DOI":"10.1183\/09031936.04.00010904","article-title":"Pulmonary-Hepatic vascular Disorders (PHD).","volume":"24","author":"R Rodr\u00edguez-roisin","year":"2004","journal-title":"Eur Respir J."},{"key":"ref-11","doi-asserted-by":"publisher","first-page":"1883-1885","DOI":"10.1183\/09031936.95.08111883","article-title":"Elevated exhaled nitric oxide in patients with hepatopulmonary syndrome.","volume":"8","author":"G Cremona","year":"1995","journal-title":"Eur Respir J."},{"key":"ref-12","doi-asserted-by":"publisher","first-page":"660-6","DOI":"10.1002\/hep.20358","article-title":"Gas exchange mechanism of orthodeoxia in hepatopulmonary syndrome.","volume":"40","author":"F G\u00f3mez","year":"2004","journal-title":"Hepatology."},{"key":"ref-13","doi-asserted-by":"crossref","first-page":"839-842","DOI":"10.1183\/09031936.94.07050839","article-title":"Is severe arterial hypoxaemia due to hepatic disease an indication for liver transplantation? 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