Richard H. Moseley, MD; Peter Traber, MD; Jorge Gumucio, MD
To the Editor: We read with interest the article by Goldsmith and coworkers (1) on primary pulmonary hypertension in five patients with classic hemophilia. Pulmonary hypertension is a recognized, although uncommon, complication of chronic liver disease (2, 3). The rarer association of pulmonary hypertension with extrahepatic portal vein obstruction in the absence of intrinsic liver disease (4) suggests that the common mechanism for the pulmonary vascular disease is portasystemic shunting of yet-to-be identified toxic substances. We, therefore, question whether the presence of intrinsic liver disease or portal hypertension, or both, was effectively excluded in their patients. In asymptomatic hemophilic patients,
Moseley RH, Traber P, Gumucio J. Pulmonary Hypertension and Liver Disease. Ann Intern Med. ;109:679. doi: 10.7326/0003-4819-109-8-679_1
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Published: Ann Intern Med. 1988;109(8):679.
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