Occult pulmonary arterial hypertension in cirrhotic patients with portal hypertension

Abstract

Portal pulmonary hypertension (PoPH) develops in frequent in patients with chronic liver diseases as the respiratory complication. PoPH, however, might be overlooked by physicians due to lack of subjective symptoms. Thus, a percentage of patients manifesting PoPH was examined in cirrhotic patients with portal hypertension through retrospective evaluation of chest X-ray images. A total of 92 patients, consisting of 42 patients with the Child-Pugh grade A liver damage and 50 patients, who were diagnosed as having cirrhosis by histological examinations were subjected to the study. Pulmonary hypertension was diagnosed through measurement of the right descending pulmonary artery (RDPA) width and the pulmonary lobar diameter to the transverse thoracic diameter (PL/T) ratio. RDPA widths were enlarged in 53 patients (57.6%) and PL/T ratios were increased in 18 patients (19.6%), and 13 cases (14.1%) fulfilled both diagnostic criteria. Percentages of patients fulfilling both criteria did not differ between patients with the Child-Pugh grade A liver damage and those with the grade B liver damage (4/42: 9.5% vs. 9/50: 18.0%, p＝0.245). PoPH was observed in more than 10% of cirrhotic patients with portal hypertension irrespective of the extent of underling liver damage.