Hepatopulmonary syndrome (HPS)

(Dig Dis Sci 2015;60:1914, Hepatology 2021;74:1014) Abnl gas exchange (A-a gradient ≥15 or PaO2 <80) caused by intrapulmonary vascular dilatations leading to intrapulmonary shunting (improves with O2) S/S: platypnea-orthodeoxia (dyspnea & hypoxia w/ sitting up), clubbing, spider angiomas Dx w/ contrast echo showing “late” A-V shunting (contrast in LA 3–6 cycles after RA) Rx: O2; potential embolization if large vessel on CT, TIPS, liver tx only definitive Rx