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Case Reports in Critical Care
Volume 2018, Article ID 3417259, 5 pages
Case Report

An Unusual Case of Refractory Hypoxia on the ICU

1Department of Anaesthesia and Critical Care, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
2Department of Respiratory Medicine, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK
3Department of Cardiology, West Suffolk NHS Foundation Trust, Bury St Edmunds, UK

Correspondence should be addressed to Nathaniel Broughton; ku.gro.srotcod@leinahtan

Received 9 January 2018; Accepted 8 March 2018; Published 17 April 2018

Academic Editor: Won S. Park

Copyright © 2018 Caroline Phillips et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We present the case of a 68-year-old gentleman who presented with breathlessness and was found to have NSTEMI, pulmonary oedema, and hypoxia. He remained hypoxic despite appropriate treatment and was found to have preserved LV function and raised cardiac output. CT pulmonary angiogram was negative but a cirrhotic liver was incidentally noted and later confirmed via ultrasound. Bedside examination was positive for orthodeoxia, suggesting a diagnosis of hepatopulmonary syndrome (HPS). The finding of significant intrapulmonary shunting on “bubble” echocardiography confirmed the diagnosis. This patient did not have previously diagnosed liver disease and had largely normal LFTs when the diagnosis was first suspected. We discuss HPS in the context of ICU and suggest how it may be screened for using simple tests. There is no correlation between the presence of HPS and severity of liver disease, yet we believe this is the first reported adult case of HPS on the ICU without previously diagnosed cirrhosis.