Hepatopulmonary syndrome and pulmonary hypertension in the same patient: A pathophysiological paradox and therapeutic dilemma

Hepatopulmonary syndrome and portapulmonary hypertension are two distinct and not commonly encountered lung diseases occurring in patients with portal hypertension. These disorders are characterized by opposite pathophysiologic pictures and have been considered mutually exclusive. Although the sequential development of these syndromes in the same patient has been described, the simultaneous presence of features of hepatopulmonary syndrome and portapulmonary hypertension is very rare. In this report, we discuss the pathophysiological paradox and therapeutic dilemma associated with such coexistence.