The Korean Journal of Nuclear Medicine (대한핵의학회지)

The Korean Society of Nuclear Medicine (대한핵의학회)
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A Case of Hepatopulmonary Syndrome Diagnosed by $^{99m}Tc-MAA$ Perfusion Lung Scan

$^{99m}Tc-MAA$ 폐관류스캔으로 진단한 간폐증후군

  • Oh, Hyung-Tae (Department of Internal Medicine, Dankook University Medical College) ;
  • Lee, Moo-Yong (Department of Internal Medicine, Dankook University Medical College) ;
  • Song, Il-Han (Department of Internal Medicine, Dankook University Medical College) ;
  • Park, Seok-Gun (Department of Nuclear Medicine, Dankook University Medical College)
  • 오형태 (단국대학교 의과대학 내과) ;
  • 이무용 (단국대학교 의과대학 내과) ;
  • 송일한 (단국대학교 의과대학 내과) ;
  • 박석건 (단국대학교 의과대학 핵의학과)
  • Published : 2002.06.30
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Abstract

In patients with chronic liver disease, hepatopulmonary syndrome, the right to left shunt without previous pulmonary and cardiac disease, can develope and cause respiratory distress. Tools to prove shunt are contrast echocardiography, pulmonary angiography, and $^{99m}Tc-MAA$ perfusion lung scan. Among them, $^{99m}Tc-MAA$ scan is a simple and safe method detecting the right to left shunt. At the same time, quantitation of shunt amount is possible by this method. We report a case of hepatopulmonary syndrome confirmed by $^{99m}Tc-MAA$ scan and contrast echocardiography with review of literlatures.

만성간질환 환자에서 호흡곤란을 초래하는 간폐 증후군 발생한다는 사실은 잘 알려져 있다. 단락을 입증하기 위해서는 대비증강심초음파, 폐혈관조영술, $^{99m}Tc-MAA$ 폐관류스캔 등을 이용할 수 있다. 이 중에서도 $^{99m}Tc-MAA$를 이용한 폐관류스캔은 매우 안전하고 간편하게 단락의 존재 여부를 확인할 수 있으며, 단락의 양을 계산할 수도 있다. 정량이 가능하므로 병의 경과를 추적하는 지표로서도 유용할 것이다. 저자들은 $^{99m}Tc-MAA$ 폐관류스캔으로 진단한 간폐증후군의 증례를 문헌고찰과 함께 보고하였다.

Keywords

References

  1. Shin JW, Song IL, Ki MJ, Rhee MY, Park SG.A study for hypoxemic mechanism in livercirrhosis. Korean J Hepatol 2000;6: 197-204.
  2. Hopkins WE, Wagner AD, Barzilai B. Frequencyand significance of intrapulmonary right-to-leftshunting in end-stage hepatic disease. Am JCardiol 1992;70:516-9.
  3. Kim JW, Kang KW, Hwang JR, Jang !G, ParkHK, Park CW et al. A case of hepatopulmonarysyndrome. Korean J Internal Medicine 1997;53:596-603.
  4. Park DY, Cha SD, Kim J, Kim BG, Yoo HS,Kim CY. A case of hepatopulmonary syndromedue to intrapulmonary shunting in a patient withliver cirrhosis. Korean J Internal Medicine1997;53:272-6.
  5. Abrams GA, Jafffe CC, Hoffer PB, Binder HJ,Fallon MB. Diagnostic utility of contrast echocardiographyand lung perfusion scan in patientswith hepatopulmonary syndrome. Gastroenterol1995;109:1283-8.
  6. Aller R, Moya JL, Moreira V, Boixeda D, CanoA, Picher J, Garcia -Rull Picher S, de Luis DA.Diagnosis of hepatopulmonary syndrome withcontrast transesophageal echocardiography. Advantagesover contrast transthoracic echocardiography.Digestive Diseases and Sciences 1999;44:1243-8.
  7. Aller R, Moreira V, Boixeda D, Moya JL, deLuis DA, Enriquez JL, Fogue L. Diagnosis ofhepatopulmonary syndrome with contrast transthoracicechocardiography and histologicalconfirmation. Liver 1998;18:285-7.
  8. Williams A, Trewby P, Williams R, Reid L.Structural alterations to the pulmonary circulationin fulminant hepatic failure. Thorax 1979;34:447-53.
  9. Krowka MJ, Tajik J, Dickson ER, Wiesner RH,Cortese DA. Intrapulmonary vascular dilatations(IPVD) in liver transplant candidates. Chest1990;97:1165-70.
  10. Vedrinne JM, Duperret S, Bizollan T, MagininC, Motin J, Trepo C, Ducerf C. Comparison oftransesophageal and transthoracic contrast echocardiographyfor detection of an intrapulmonary shuntin liver disease. Chest 1997;111:1236-40.
  11. Gates GF, Orme HW, Dore EK: Measurementof cardiac shunting with technetium- labeledalbumin aggregates. J Nucl Med 1971;12:746-9.
  12. Bolstad DM, Valley TB, Wilson ME, Hung JC.An improved technique for reducing the numberof particle in a technetium-99m macroaggregatedalbumin injection. J Nucl Med Technol 1992;20:220-3.
  13. Cheng KT, Spicer KM, Gordin L. The preparationparameters of technetium-99m-macroag·gregated albumin-low particle number. J Nucl MedTechol 1994;22:173-7.
  14. Dogan AS, Rezai K, Kirchner PT, Stuhlmur JE.A scintigraphic sign for detection of right-to-leftshunts. J Nucl Med 1993;34: 1607-113.
  15. Lee KY, Kim YH, Han SK, Shim YS, Kim KY,Han yc. Hypoxemia in liver cirrhosis andintrapulmobary shunt determination using Tc99m-MAA whole body scan. Tuberculosis andRespiratory Disease 1994; 41:504-512.
  16. Rieger JL, Lang KA, Johnson SP, WestermanJH. Transjugular intrahepatic portosystemic shuntimproves oxygenetion in hepatopulmonary syndrome.Gastroenterol 1995;109: 978-83.
  17. Levin DP, Brandit M, Weber A, Paradis K,Laberge JM, Blanchard H. Reversal ofintrapulmonary shunting in cirrhosis after livertransplantation demonstrated by perfusion lungscan. J Nucl Med 1991; 32:862-4.