Lessons to be learned: a case study approach A case study of the temporal onset of pulmonary hypertension with pre-existent cirrhotic portal hypertension

Abstract

We report the occurrence of pulmonary hypertension in a 37-year-old male patient with cirrhosis of the liver, portal hyperten sion and oesophageal varices. Although this is a rare combination, previous reports have shown that the association of portal and pulmonary hypertension is not coinci dental; the temporal onset of primary pul monary hypertension is hard to predict and our patient was asymptomatic for a number of years. The pathogenesis of portal hypertension leading to pulmonary hyper tension is not known. Diagnosis is difficult because the clinico-pathological symptoms in both conditions are similar. Treatment is limited to calcium channel blockers, vasodilators, nitrous oxide and prostacyclin, although most patients will eventually require visceral transplantation.