著明な低酸素血症と続発性の赤血球増加症を伴った肝硬変症の1例

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A 57-year-old female patient with liver cirrhosis complicated with marked hypoxemia and secondary erythrocytosis was reported. She was admitted to our hospital because of cyanosis at nail bed and lips. Arterial oxygen tension under room air was 33mmHg, arterial carbon dioxide tension was 45mmHg. Hematological examination showed marked erythrocytosis (RBC was 591×104 and Hb was 19.7g/dl). Laparoscopic and histologic findings proved to be the liver cirrhosis. The pulmonary perfusion scanning by 99mTc MAA showed significant uptake not only in lungs but also in spleen, thyroid glands and both kidneys. Furthermore, dynamic pulmonary perfusion scanning revealed gradually decrease of uptake in lungs. However, the "shunt ratio" measured after 100% oxygen inhalation was 6.9% when the standard shunt equation was utilized. We speculated that this discrepancy might be due to the abnormaly dilatated alveolar-capillary vesseles. Erythrocytosis was considered to be the secondary change resulted from hypoxemia.