A carregar...
Publicação
Síndrome hepatopulmonar : importância da suspeição diagnóstica
| Nome: | Descrição: | Tamanho: | Formato: | |
|---|---|---|---|---|
| 1.48 MB | Adobe PDF |
Autores
Orientador(es)
Resumo(s)
A cirrose hepática pode apresentar envolvimento de múltiplos órgãos e sistemas nomeadamente coração, pulmões, cérebro, músculo-esquelético, sistema imunitário, entre outros.
Diversas entidades podem estar na base do surgimento de dispneia num doente com cirrose hepática, sendo as principais a Síndrome HepatoPulmonar (SHP), Hipertensão PortoPulmonar e Hidrotórax Hepático.
A SHP é a complicação mais frequente, com prevalência entre 4% e 32%, porém o seu caráter frequentemente assintomático ou de dispneia inespecífica torna-a altamente subdiagnosticada. Acarreta mau prognóstico com 23% de sobrevivência aos 5 anos e elevada morbilidade realçando o papel central do diagnóstico precoce, pelo que a investigação ativa da SHP é essencial na gestão de doentes hepáticos.
Apresenta-se o caso de um homem de 66 anos com hipertensão portal e cirrose hepática secundária a infeção crónica por VHC com erradicação viral em 2015, que surge com dispneia de agravamento progressivo e concomitantemente com um nódulo hepático que se veio a revelar compatível com Carcinoma Hepatocelular (CHC).
A suspeita de CHC e a apresentação simultânea com uma outra intercorrência médica contribuíram para o atraso na colocação da hipótese diagnóstica de SHP. Apesar disto, o doente foi transplantado de forma célere conseguindo-se reverter as alterações respiratórias causadas pela SHP.
Liver cirrhosis may involve multiple organs and systems such as heart, lungs, brain, musculoskeletal, immune system, among others. Several entities may be at the basis of the onset of dyspnea in a patient with hepatic cirrhosis, the main ones being HepatoPulmonary Syndrome (HPS), Portopulmonary Hypertension and Hepatic Hydrothorax. HPS is the most frequent complication, with prevalence between 4% and 32%, but it’s frequently asymptomatic or nonspecific dyspnea character makes it highly underdiagnosed. It causes poor prognosis with 23% survival at 5 years and high morbidity highlighting the central role of early diagnosis, so active HPS investigation is essential in the management of liver patients. We present the case of a 66-year-old man with portal hypertension and liver cirrhosis secondary to chronic HCV infection with viral eradication in 2015, who presented with progressive worsening dyspnea and concomitantly with a liver nodule that turned out to be compatible with Hepatocellular Carcinoma (HCC). The suspicion of HCC and simultaneous presentation with another medical complication contributed to the delay in the diagnosis of HPS. Despite this, the patient was rapidly transplanted and the respiratory alterations caused by HPS were reversed.
Liver cirrhosis may involve multiple organs and systems such as heart, lungs, brain, musculoskeletal, immune system, among others. Several entities may be at the basis of the onset of dyspnea in a patient with hepatic cirrhosis, the main ones being HepatoPulmonary Syndrome (HPS), Portopulmonary Hypertension and Hepatic Hydrothorax. HPS is the most frequent complication, with prevalence between 4% and 32%, but it’s frequently asymptomatic or nonspecific dyspnea character makes it highly underdiagnosed. It causes poor prognosis with 23% survival at 5 years and high morbidity highlighting the central role of early diagnosis, so active HPS investigation is essential in the management of liver patients. We present the case of a 66-year-old man with portal hypertension and liver cirrhosis secondary to chronic HCV infection with viral eradication in 2015, who presented with progressive worsening dyspnea and concomitantly with a liver nodule that turned out to be compatible with Hepatocellular Carcinoma (HCC). The suspicion of HCC and simultaneous presentation with another medical complication contributed to the delay in the diagnosis of HPS. Despite this, the patient was rapidly transplanted and the respiratory alterations caused by HPS were reversed.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2020
Palavras-chave
Síndrome hepatopulmonar Dispneia Hipoxémia Transplante Gastroenterologia