Volume 155, Issue 1, Pages 123-136 (January 2019) Evidence for an Association Between Intrahepatic Vascular Changes and the Development of Hepatopulmonary Syndrome  Clément Lejealle, MD, Valérie Paradis, MD, PhD, Onorina Bruno, MD, Emmanuelle de Raucourt, MD, PhD, Claire Francoz, MD, PhD, Olivier Soubrane, MD, PhD, Didier Lebrec, MD, PhD, Pierre Bedossa, MD, PhD, Dominique Valla, MD, PhD, Hervé Mal, MD, PhD, Valérie Vilgrain, MD, PhD, François Durand, MD, PhD, Pierre-Emmanuel Rautou, MD, PhD  CHEST  Volume 155, Issue 1, Pages 123-136 (January 2019) DOI: 10.1016/j.chest.2018.09.017 Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 1 Imaging features associated with hepatopulmonary syndrome (HPS). A-H, Axial abdominal contrast-enhanced multidetector CT scanning during portal phase (A, B, C, D, E, F) and arterial phase (G, H) in patients with cirrhosis without (A, C, E, G) and with (B, D, F, H) HPS. A, Visible portal branches (arrowheads). B, Invisible portal branches (arrows). C, Thin splenorenal shunts (arrowhead). D, Large splenorenal shunts (arrow). E, Thin paraumbilical vein (arrowhead). F, Large paraumbilical vein (arrow). G, “Normal” hepatic artery (arrowhead). H, Enlarged hepatic artery (arrow). CHEST 2019 155, 123-136DOI: (10.1016/j.chest.2018.09.017) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 2 Intrahepatic vascular changes associated with hepatopulmonary syndrome (HPS). A-H, Hematoxylin and eosin staining of liver explants from patients with cirrhosis without (A, C, E, G) and with (B, D, F, H) HPS. A, Patent intrahepatic portal venule (arrowhead) (original magnification, ×140). B, Intrahepatic portal venules thrombosis (arrows) (original magnification, ×280). C, Fibrous septa without vascular proliferation (arrowheads) (original magnification, ×80). D, Vascular proliferation (increased number of venous channels) within fibrous septa (arrows) (original magnification, ×80). E, “Normal” centrilobular venule (arrowheads) (original magnification, ×140). F, Wall thickening of centrilobular venule (arrows) (original magnification, ×140). G, Permeable intrahepatic hepatic venule (arrowhead) (original magnification, ×280). H, Intrahepatic hepatic venule thrombosis (arrows) (original magnification, ×140). CHEST 2019 155, 123-136DOI: (10.1016/j.chest.2018.09.017) Copyright © 2018 American College of Chest Physicians Terms and Conditions

Figure 3 Architectural and lobular changes associated with hepatopulmonary syndrome (HPS). A-F, Hematoxylin and eosin (A, B, E, F) and picrosirius (C, D) staining of liver explants from patients with cirrhosis without (A, C, E) and with (B, D, F) HPS. A, No dilated liver sinusoids (arrowheads) (original magnification, ×190). B, Centrilobular sinusoidal dilatation (arrows) (original magnification, ×190). C, “Usual” fibrous septa (arrows) surrounding hepatocytes nodules (arrowheads) (original magnification, ×28). D, Large area of confluent fibrosis (arrows) with small nodules of hepatocytes (arrowheads) (original magnification, ×28). E, “Usual” complete septa delimiting hepatocytes nodules (arrowheads) (original magnification, ×56). F, Thin and incomplete septa (arrows) delimiting hepatocyte nodules (original magnification, ×56). CHEST 2019 155, 123-136DOI: (10.1016/j.chest.2018.09.017) Copyright © 2018 American College of Chest Physicians Terms and Conditions