• SOM 4th Yr Curriculum

• CLERKSHIP INFORMATION
• Introduction / Goals and Objectives
• Rotations
  • HMC
  • UWMC
  • VAMC
• Seminars
• Faculty Only
• PULMONARY EDUCATION
• Pulmonary Med Library
• Arterial Blood Gases
• Cardiopulmonary Exercise Testing
• Mechanical Ventilation
• Pulmonary Function Testing
• Pleural Effusion
• Radiology

Pulmonary Function Testing

Case 12 Answer

A 44 year-old woman with cirrhosis secondary to chronic alcohol abuse and Hepatitis C presents with complaints of increasing dyspnea. She reports that her dyspnea is worse when she is sitting upright or walking but improves when she is lying flat. She is an active cigarette smoker. On exam, she has a room air oxygen saturation of 88% in the sitting position and a room air oxygen saturation of 96% in the supine position.

Her pulmonary function testing is as follows:

A flow-volume loop is not available for this case.

Case 12 Interpretation

The patient has normal FVC and FEV₁ but a reduced FEV₁/FVC ratio. Even though the FEV₁ is within the normal range, she would, therefore, be classified as having mild obstructive lung disease because of the reduced FEV₁/FVC ratio. There is no evidence of a bronchodilator response and the lung volumes are normal. Her DLCO, however, is markedly reduced and the reduction is far out of proportion to the abnormalities seen in her spirometry. This suggests that she may, in fact, have a pulmonary vascular problem.

Patients with chronic liver disease are predisposed to several pulmonary vascular problems including portopulmonary hypertension and hepatopulmonary syndrome. The latter disorder is marked by the presence of intrapulmonary shunts, which occur predominantly at the bases of the lungs. Both of these problems can cause an isolated reduction in the DLCO on pulmonary function testing. In her case, she has a symptom (platypnea – dyspnea that is worse in the upright position compared to the supine position) and a sign (orthodeoxia – oxygen saturation or PaO₂ is worse in the upright position compared to the supine position) that are both highly suggestive of the presence of intrapulmonary shunts and, therefore, a diagnosis of hepatopulmonary syndrome.

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