Functional Tricuspid Stenosis in Primary Sclerosing Cholangitis: A Case Report
Authors: Rodrigo Mendirichaga, Rhanderson Cardoso, Daniel Garcia, Marian Calfa, Victor Soto
Journal: Annals of Internal Medicine (2016)

Letters3 May 2016Functional Tricuspid Stenosis in Primary Sclerosing Cholangitis: A Case ReportRodrigo Mendirichaga, MD, Rhanderson Cardoso, MD, Daniel Garcia, MD, Marian Calfa, MD, and Victor Soto, MDRodrigo Mendirichaga, MDFrom University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami, Florida.Search for more papers by this author, Rhanderson Cardoso, MDFrom University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami, Florida.Search for more papers by this author, Daniel Garcia, MDFrom University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami, Florida.Search for more papers by this author, Marian Calfa, MDFrom University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami, Florida.Search for more papers by this author, and Victor Soto, MDFrom University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami, Florida.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-0403 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: Thirty percent of patients with primary sclerosing cholangitis may have severe hypertrophy of the caudate lobe of the liver (1).Objective: To report what we believe is the first case of tricuspid stenosis secondary to extrinsic compression of the heart from hypertrophy of the caudate lobe in primary sclerosing cholangitis.Case Report: A 71-year-old woman with a history of primary sclerosing cholangitis reported worsening positional dyspnea during several outpatient visits. Dyspnea increased when she stood and decreased when she lay down (platypnea–orthodeoxia syndrome). The patient had ascites, and we could elicit a fluid wave; however, therapeutic paracentesis only minimally ...References1. Dodd GD, Baron RL, Oliver JH, Federle MP.. End-stage primary sclerosing cholangitis: CT findings of hepatic morphology in 36 patients. Radiology. 1999;211:357-62. [PMID: 10228514] CrossrefMedlineGoogle Scholar2. Rodríguez-Roisin R, Krowka MJ. Hepatopulmonary syndrome—a liver-induced lung vascular disorder. N Engl J Med. 2008;358:2378-87. [PMID: 18509123] doi:10.1056/NEJMra0707185 CrossrefMedlineGoogle Scholar3. Krowka MJ, Cortese DA. Hepatopulmonary syndrome: an evolving perspective in the era of liver transplantation. Hepatology. 1990;11:138-42. [PMID: 2403962] CrossrefMedlineGoogle Scholar4. Lange PA, Stoller JK. The hepatopulmonary syndrome. Ann Intern Med. 1995;122:521-9. [PMID: 7872588] LinkGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From University of Miami Miller School of Medicine-Jackson Memorial Hospital, Miami, Florida.Note: Drs. Mendirichaga and Cardoso contributed equally to this work.Disclosures: Authors have disclosed no conflicts of interest. Forms can be viewed at www.acponline.org/authors/icmje/ConflictOfInterest Forms.do?msNum=L15-0403.This article was published at www.annals.org on 23 February 2016. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics 3 May 2016Volume 164, Issue 9Page: 639-640KeywordsDyspneaEchocardiographyHeartLeft atriumLiverPatient advocacyPrimary sclerosing cholangitisRight ventricleRight ventricular outflow tractStenosis ePublished: 23 February 2016 Issue Published: 3 May 2016 Copyright & PermissionsCopyright © 2016 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...