Co-existence of hepato-pulmonary syndrome and pulmonary hypertension in a patient with liver cirrhosis and intravenous drug abuse

We describe a patient who had a history of cirrhosis and intravenous drug abuse. He had findings of the hepato-pulmonary syndrome and pulmonary hypertension. The co-existence of the hepato-pulmonary syndrome and pulmonary hypertension may be attributable to two separate processes: (a) cirrhosis causing pulmonary vascular dilatation at the pulmonary capillary level resulting in the hepato-pulmonary syndrome and (b) intravenous drug abuse causing narrowing of pulmonary vascular bed at the level of small pulmonary arteries, thereby, resulting in pulmonary hypertension with elevated pulmonary vascular resistance. However, the co-existence of the hepato-pulmonary syndrome and porto-pulmonary hypertension remains a distinct possibility.