Value of contrast echocardiography for the diagnosis of hepatopulmonary syndrome

The hepatopulmonary syndrome must be suspected in patients with end-stage liver disease and refractory hypoxemia. We report a case of a 49-year-old woman with hypoxemia and cirrhosis referred to the cardiac ultrasound laboratory in the evaluation of liver transplantation. Contrast-enhanced echocardiography with intravenous injection of agitated saline solution was crucial to obtain the definitive diagnosis. This imaging modality has proven to be a valuable tool in detecting intrapulmonary right-to-left shunt. The present case emphasizes the usefulness of contrast echocardiography in the diagnosis of a noncardiac disease with important prognosis implications.