Brazilian Journal of Pulmonology

ISSN (on-line): 1806-3756 | ISSN (printed): 1806-3713


Publication continuous and bimonthly

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Pulmonary function in hepatic cirrhosis

Função pulmonar na cirrose hepática

Eduardo Garcia, Américo de Oliveira Silvério, Ajácio Bandeira de Melo Brandão, José Silva Moreira

J Bras Pneumol.1997;23(5):225-230

Abstract PDF PT

Presence of arterial hypoxemia in hepatic cirrhosis is a well-documented fact. Physiopathogenic mechanisms have been widely studied. It is assumed that there are alterations in pulmonary vessels which determine small and numerous arteriovenous shunts. Presence of anatomic intrapulmonary shunts, although well-documented, is small and could hardly explain such low levels of arterial oxigenation in cirrhotic patients. It is a premise that alterations occur in the pulmonary dynamics and that the diffusion of gases may be altered. Purpose: To evaluate the pulmonary function and arterial oxygenation levels in 55 patients with hepatic cirrhosis, with no other pulmonary, cardiac or hematologic diseases. They were submitted to evaluation of the pulmonary function through measurement of the forced vital capacity, forced expiratory volume in one second, and residual volume as well as diffusion capacity for carbon monoxide. Finally, arterial oxygenation was evaluated through arterial gasometry during air breathing and with 100% oxygen. Analysis of results allowed the authors to observe the presence of normal pulmonary flows and volumes (average of: FVC = 104.6%; FEV1 = 102.4%; residual volume = 117.4%); and diffusion capacity was diminished (average = 70.8%) in relation to predicted values. Arterial blood gases showed a mean PaO2 of 81.20 mmHg during air breathing and 515.4 mmHg when 100% oxygen was breathed. No correlations among PaO2 (with air breathing and with oxygen) and diffusion capacity were observed. In this study, flows and pulmonary volumes were normal in relation to the predicted values; however, diffusion of carbon monoxide was diminished. This diminished diffusion corroborates the existing idea of the so-called diffusion-perfusion imbalance as one of the mechanisms involved in the physiopathology of the hepatic pulmonary syndrome, even with no evidence of intrapulmonary morphological arteriovenous shunt.


Keywords: Hepatopulmonary syndrome. Pulmonary function. Hepatic cirrhosis.


Portopulmonary hypertension

Hipertensão portopulmonar

Eduardo Garcia, José Silva Moreira, Ajácio Bandeira de Melo Brandão, Alessandra Isabel Zille, Juliana Cardozo Fernandes

J Bras Pneumol.2005;31(2):157-161

Abstract PDF PT PDF EN Portuguese Text

Portal hypertension and cirrhosis can result in complex changes in the pulmonary vascular bed, the most important among them being the hepatopulmonary syndrome and portopulmonary hypertension. When pulmonary hypertension accompanies cirrhosis and portal hypertension, it is seldom diagnosed. Its prevalence is estimated to range from 1% to 2% in patients with portal hypertension or cirrhosis, regardless of gender, and the condition is predominantly seen in patients in their 40s. Etiologic factors have not been sufficiently well defined to explain the increase in pulmonary artery pressure and pulmonary vascular resistance. Most patients are asymptomatic until developing dyspnea on exertion, which generally occurs when the mean pulmonary artery pressure exceeds 40 mmHg. Concomitant hepatic disease with progressive hypoxemia or right ventricular failure increase mortality rates. Further studies are needed in order to determine the benefits of using oral, inhaled or intravenous vasodilators, as well as to evaluate the outcomes of liver transplant, which may be the sole definitive therapeutic option.


Keywords: Key words: Oxygen free radicals. Antioxidant substances. Oxidative stress. Lung diseases.


Bronchial casts attributed to the use of pegylated interferon and ribavirin

Molde brônquico devido ao uso de interferon peguilado e ribavirina

Eduardo Garcia, Ângelo Ferreira da Silva Junior, Fabíola Schorr, Milene Hota, Ricardo Gondim Brizzi, André Barreto da Silva

J Bras Pneumol.2009;35(7):713-716

Abstract PDF PT PDF EN Portuguese Text

We report the case of a 53-year-old male patient with a rare profile: bronchial casts associated with the use of pegylated interferon and ribavirin. The patient sought treatment in a pulmonology clinic with a history of progressive dyspnea for four months that had evolved to progressive cough followed by frequent and abundant elimination of bronchial casts. The patient was initially treated with bronchodilators, as well as with oral and inhaled corticosteroids. Fiberoptic bronchoscopy, bronchoalveolar lavage and sputum analysis were carried out but did not contribute to the elucidation of the diagnosis. The symptoms developed while the patient was receiving pegylated interferon and ribavirin for the treatment of hepatitis C. The symptoms resolved 30 days after the discontinuation of the treatment. To our knowledge, this is the first report of bronchial casts caused by the use of pegylated interferon and ribavirin.


Keywords: Bronchitis; Interferons/adverse effects; Ribavirin/adverse effects.


The chest and aging: radiological findings

O tórax e o envelhecimento: manifestações radiológicas

Bruno Hochhegger, Gustavo Pontes de Meireles, Klaus Irion, Gláucia Zanetti, Eduardo Garcia, José Moreira, Edson Marchiori

J Bras Pneumol.2012;38(5):656-665

Abstract PDF PT PDF EN Portuguese Text

In the elderly (conventionally defined as individuals  60 years of age), it is often difficult to establish what normality is, because of the numerous anatomical and physiological modifications that occur during the aging process. As a result, the greatest challenge is to differentiate between the normal aging process and the onset of disease. Healthy elderly people commonly present borderline findings on chest imaging. We systematically reviewed the medical literature on the subject, covering the period between 1950 and 2011, including articles in Portuguese, English, French, Italian, and Spanish. We searched the PubMed, LILACS, and SciELO databases, using the search terms "age", "aging", "lung", "thorax", "chest", "X-ray", "radiography", "pulmonary", and "computed tomography"-as well as their corresponding translations-in various combinations. We included only original or review articles on aging-related chest imaging findings. In broad terms, aging results in physiological modifications that must be recognized so as not to be erroneously interpreted as pathological.


Keywords: Aging; Thorax; Lung; Diagnostic imaging.




The Brazilian Journal of Pulmonology is indexed in:

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CNPq, Capes, Ministério da Educação, Ministério da Ciência e Tecnologia, Governo Federal, Brasil, País Rico é País sem Pobreza
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