SPONTANEOUS IMPROVEMENT IN A PATIENT WITH THE HEPATOPULMONARY SYNDROME ASSESSED BY SERIAL EXERCISE TESTS

A 37 year old patient with chronic active hepatitis progressing to cir rhosis presented with increasing breathlessness and was found to be hy poxic with finger clubbing. A progressive exercise study with measurem ent of oxygen saturation (Sao(2)) showed abnormally high ventilation a nd desaturation to 81% at 100 W. Serial studies over nearly two years showed, first, deterioration, then improvement with lower ventilation and higher saturation levels at all work loads. This could not be corr elated with any change in treatment with azathioprine, prednisolone, o r propranolol.