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Volume 359:866-867 August 21, 2008 Number 8
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The Hepatopulmonary Syndrome

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by Rodríguez-Roisin, R.
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To the Editor: In their review of the hepatopulmonary syndrome, Rodríguez-Roisin and Krowka (May 29 issue)1 provide a pathophysiological explanation of the symptoms of this syndrome, but they downplay the importance of the history and physical examination in making the diagnosis, stating that there are no signs, symptoms, or hallmarks of the hepatopulmonary syndrome on physical examination. We disagree. Platypnea (the opposite of orthopnea) not only is a common symptom, but also is almost diagnostic in itself in a patient with cirrhosis. Many patients with the hepatopulmonary syndrome also have cyanosis and clubbing, an unusual combination in cirrhosis.

We believe . . . [Full Text of this Article]



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