Snapshot A 60-year-old man presents with increasing shortness of breath. He reports that this symptom worsens when he is in the upright position and improves when he is laying in bed. Medical history is significant for end-stage liver disease due to hepatitis C infection. On physical exam, there is decreased breath sounds on pulmonary auscultation and spider nevi. Arterial blood gas analysis is significant for an alveolar-arterial gradient of 20 mmHg. Introduction Clinical definition login to view 1 more bullet Epidemiology Incidence login to view 2 more bullets Demographic login to view 2 more bullets Location login to view 1 more bullet Risk factors login to view 3 more bullets ETIOLOGY Pathophysiology login to view 5 more bullets Associated conditions login to view 2 more bullets Presentation Symptoms login to view 4 more bullets Physical exam login to view 8 more bullets Imaging Transthoracic contrast echocardiography login to view 5 more bullets Studies Labs login to view 5 more bullets Differential Arteriovenous malformations Atrial septal defect Hepatic hydrothorax Portopulmonary hypertension Anemia Treatment Conservative login to view 6 more bullets Operative login to view 3 more bullets Complications Pneumonitis Panacinar emphysema Prognosis Liver transplantation may result in resolution of hepatopulmonary syndrome