Lung Abnormalities in Liver Cirrhosis


  • Muli Yaman Department of Pulmonology and Respiratory Medicine Faculty of Medicine, Universitas Brawijaya, Malang, Indonesia
  • Syifa Mustika Division of Gastroenterohepatology, Department of Internal Medicine,Universitas Brawijaya – RSUD Dr. Saiful Anwar Malang, Indonesia



Cirrhosis Hepatis, Hepatopulmonary Syndrome, Portopulmonary Hypertension, Hepatic Hydrothorax, Spontaneous Bacterial Empyema


Regardless of preexisting lung illness, patients suffering from liver cirrhosis, especially decompensated liver cirrhosis can develop distinct pulmonary complications. Liver cirrhosis patients should be assessed for hepatopulmonary syndrome (HPS), portopulmonary hypertension (PoPH), hepatic hydrothorax (HH) and spontaneous bacterial empyema (SBEM)  which are the most clinically significant pulmonary consequences, in particular when dyspnea develops in conjunction with hepatic cirrhosis. These entities differ in terms of pathophysiology, clinical characteristics, diagnosis and suitable treatment options. This emphasize the need of specific diagnostic algorithm in liver cirrhosis patients presenting with dyspnea or other pulmonary symptoms. These pulmonary complications might be rare in patients with liver cirrhosis and portal hypertension but these complications might carry significant morbidity and mortality risks and, therefore, strong clinical suspicion is required to make an early accurate diagnosis. There are several medical therapies available for each condition in the multiple studies but most of the treatments and proceures doesn’t have significant benefit or have short lived benefit. The only treatment that changes the clinical prognosis of decompensated cirrhosis effectively in long term is liver transplantation. However liver transplantation also needs careful considerations as on some cases it might increase the risk of morbidity and mortality.


Keywords:  Cirrhosis Hepatis, Hepatopulmonary Syndrome, Portopulmonary Hypertension, Hepatic Hydrothorax, Spontaneous Bacterial Empyema


Bashar S, John S. Hepatic Cirrhosis. StatPearls. [Internet] 2022 [cited 2023 Mar 9]. Available from:

Bansal K, S Gore, Mittal S. Hepatopulmonary Syndrome. StatPearls. [Internet] 2022 [cited 2023 Mar 6]. Available from:

Benz F, Mohr R, Tacke F, Roderburg C. Pulmonary complications in patients with liver cirrhosis. J Transl Intern Med. 2020;8(3):150–8.

Soulaidopoulos S, Goulis I, Cholongitas E. Pulmonary manifestations of chronic liver disease: A comprehensive review. Ann Gastroenterol. 2020;33(3):237–49.

Shenoda B, Boselli J. Vascular syndromes in liver cirrhosis. Clin J Gastroenterol. [Internet] 2019 [cited 2023 Mar 8] ;12(5):387–97. Available from:

Menteri Kesehatan Republik Indonesia. Keputusan Menteri Kesehatan Republik Indonesia Nomor HK.01.07/MENKES/15/2023. Keputusan Menteri Kesehatan Republik Indonesia. 2023.

Kasper DL, Fauci AS, Hauser SL, Longo DL, Jameson JL, Loscalzo J. Harrison’s Gastroenterology and Hepatology. Mc Graw Hill Education. 2017. 456–470 p.

Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet. 2021;398(10308):1359–76.

Berumen J, Baglieri J, Kisseleva T, Mekeel K. Liver fibrosis: Pathophysiology and clinical implications. WIREs Mech Dis. 2021;13(1):1–17.

Engelmann C, Clària J, Szabo G, Bosch J, Bernardi M. Pathophysiology of decompensated cirrhosis: Portal hypertension, circulatory dysfunction, inflammation, metabolism and mitochondrial dysfunction. J Hepatol. 2021;75(Suppl 1):S49–66.

Slevin E, Baiocchi L, Wu N, Ekser B, Sato K, Lin E, et al. Kupffer Cells: Inflammation Pathways and Cell-Cell Interactions in Alcohol-Associated Liver Disease. Am J Pathol. [Internet] 2020 [cited 2023 Mar 7] ;190(11):2185–93. Available from:

Meseeha M, Attia M. Esophageal Varics. Pubmed Cent. [Internet] 2022 [cited 2023 Mar 9]; Available from:

Iqbal S, Smith KA, Khungar V. Hepatopulmonary Syndrome and Portopulmonary Hypertension: Implications for Liver Transplantation. Clin Chest Med. 2020;38(4):785–95.

Thomas C, Glinskii V, de Jesus Perez V, Sahay S. Portopulmonary Hypertension: From Bench to Bedside. Front Med. 2020;7(November):1–12.

Matyas C, Haskó G, Liaudet L, Trojnar E, Pacher P. Interplay of cardiovascular mediators, oxidative stress and inflammation in liver disease and its complications. Nat Rev Cardiol. 2021;18(2):117–35.

Raevens S, Boret M, De Pauw M, Fallon MB, Van Vlierberghe H. Pulmonary Abnormalities in Liver Disease: Relevance to Transplantation and Outcome. Vol. 74, Hepatology. 2021. 1674–1686 p.

Cartin-Ceba R, Burger C, Swanson K, Vargas H, Aqel B, Keaveny AP, et al. Clinical Outcomes after Liver Transplantation in Patients with Portopulmonary Hypertension. Transplantation. 2021;105(10):2283–90.

Tokushige K, Kogiso T, Egawa H. Current Therapy and Liver Transplantation for Portopulmonary Hypertension in Japan. J Clin Med. 2023;12(2):562.

Dubrock H, Runo JR, Sadd CJ, Burger C, Cartin-Ceba R, Rosen C, et al. Outcomes of Liver Transplantation in Treated Portopulmonary Hypertension Patients With a Mean Pulmonary Arterial Pressure ≥35 mm Hg. Pubmed Cent. [Internet] 2020 [cited 2023 Mar 6];6(12). Available from:

Li J, Zhuang Q, Zhang X, Zheng Y, Qiao Z, Zhang J, et al. Prevalence and prognosis of portopulmonary hypertension in 223 Liver Transplant recipients. Can Respir J. 2018;2018.

Lv Y, Han G, Fan D. Hepatic hydrothorax. Ann Hepatol. 2018;17(1):33–46.




How to Cite

Muli Yaman, & Mustika, S. (2023). Lung Abnormalities in Liver Cirrhosis. Clinical and Research Journal in Internal Medicine, 4(2), 470–480.