The liver plays a central role in organism homeostasis and metabolism and it has important interactions with every organ system,
that is why patients with chronic liver disease exhibit various pulmonary and abdominal complications.
We review and illustrate the most important complications of cirrhosis.
These complications include hepatopulmonary syndrome,
portopulmonary hypertension,
intrathoracic portosystemic collateral vessels,
bacterial infections,
acute respiratory distress syndrome (ARDS) and pleural effusion.
Possible abdominal complications include bleeding from esophageal and gastric varices, splenic infarction and splenomegaly,
ascites,
bacterial peritonitis,
collateral vessels and shunts
Fig. 1
THORACIC COMPLICATIONS
1.
Hepatopulmonary syndrome
Fig. 3
Fig. 4: Hepatopulmonary syndrome. (a) Axial thin-slab maximun intensity projection CT image shows enlarged pulmonary arteries and slightly dilated subpleural vessels.
(b)CT scan in lung window shows the dilated subpleural vessels that extend toward the lung periphery and nodular dilatation of peripheral pulmonary vessels (arrow).
(Courtesy of Dra.Torres and Dra.Fernández-Velilla. Hospital La Paz, Madrid, Spain)
References: Dra. Torres and Dra. Fernández-Velilla. Department of Radiology, Hospital La Paz, Madrid, Spain
2.
Portopulmonary Hypertension
Fig. 2: Contrast-enhanced CT scan shows a widened main pulmonary artery with a diameter greater than that of the ascending aorta. Enlarged pulmonary arteries are also noted. (Courtesy of Dra.Torres and Dra.Fernández-Velilla. Hospital La Paz, Madrid, Spain)
References: Dra. Torres and Dra.Fernández-Velilla. Department of Radiology.Hospital La Paz, Madrid, Spain
3.
Intrathoracic portosystemic collateral vessels
Fig. 5
Fig. 6: Axial contrast-enhanced CT images show dilated paraesophageal varices and numerous large cardiophrenic veins surrounding the esophagus and descending thoracic aorta
4.
Hepatic Hydrothorax
Fig. 7
Fig. 8: Contrast –enhanced CT scans show a large amount of pleural effusion in the right hemithorax in differents patients with cirrhosis
5.
Acute Respiratory Distress Syndrome
Fig. 9: Contrast-enhanced CT scan shows diffuse ground-glass opacity in both lungs and more extensive dependent consolidation and pleural effusion
ABDOMINAL EXTRAHEPATIC COMPLICATIONS
1.
Splenomegaly and Splenic Infarction
Fig. 10
Fig. 11
2.
Ascites
Fig. 12
Fig. 13
Fig. 14
3.
Spontaneous or primary bacterial peritonitis (SBP)
Fig. 15
Fig. 16
4.
Collateral Vessels and Shunts
Fig. 17
Fig. 18
Fig. 19
CT angiography plays an important role to show the variceal anatomy that provides a more thorough understanding of the variceal orientation and relationship to adjacent organs.
It is important because these collateral vessels can interfere with any abdominal surgery or any procedure in which an unexpected varix can results in significant bleeding. For example, recanalized paraumbilical veins in a large abdominal incision.
Fig. 20
Infections
Fig. 21
Fig. 22