A 76-year-old man was admitted to our hospital because of
dyspnea. Three years before admission,
dyspnea was recognized and had been given a diagnosis of
interstitial pneumonia by a general physician. A year later, he received home
oxygen therapy. After admission, we found that he had
alcoholic liver cirrhosis and an increased alveolar-arterial
oxygen level in his arterial blood gas. Moreover, he had an intrapulmonary vascular shunt, detected by contrast-enhanced echocardiography and perfusion scan with 99mTc-macroaggregated
albumin. These results confirmed
hepatopulmonary syndrome. Furthermore, exhaled
nitric oxide (NO) was elevated in the patient although he had never had
bronchial asthma or any other allergic diseases. Animal models of
hepatopulmonary syndrome have shown that exhaled NO is associated with dilated vessels. To the best of our knowledge, this paper describes the first case of
hepatopulmonary syndrome with elevated exhaled NO in Japan.