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Nigel Dewey, Andrew R Houghton and Jeffrey Khoo

Open access

James Offer, Lawrence Green, Andrew R Houghton and Jim Campbell


This report presents the case of a 42-year-old man with liver cirrhosis who presents with breathlessness. Initial investigations are unable to explain his persistent hypoxia and a diagnosis of hepatopulmonary syndrome is considered. Saline contrast echocardiography is utilised in confirming the diagnosis. Details of this case as well as practicalities in performing and interpreting saline contrast echocardiography are reviewed.

Learning points

  • Key features of hepatopulmonary syndrome are liver disease, hypoxia and pulmonary vascular dilatations.
  • Saline contrast echocardiography is a simple inexpensive procedure to perform and key to confirming the diagnosis of hepatopulmonary syndrome. Detection can be improved by performing the scan in the stand-up position.
  • Agitated saline contrast studies are more commonly performed to identify intra-cardiac shunts. Timing of contrast arrival in the left heart chambers is key to differentiating intra-cardiac shunting from extra-cardiac pulmonary transit.

Open access

Nigel Dewey, Lal Hussain Mughal, Andrew R Houghton and Jeffrey Khoo

Open access

Sarah Ritzmann, Stephanie Baker, Marcus Peck, Tom E Ingram, Jane Allen, Laura Duffy, Richard P Steeds, Andrew Houghton, Andrew Elkington, Nina Bual, Robert Huggett, Keith Pearce, Stavros Apostolakis, Khalatabari Afshin and the British Society of Echocardiography Departmental Accreditation and Clinical Standards Committees with input from the Intensive Care Society

This article sets out a summary of standards for departmental accreditation set by the British Society of Echocardiography (BSE) Departmental Accreditation Committee. Full accreditation standards are available at The BSE were the first national organisation to establish a quality standards framework for departments that support the practice of individual echocardiographers. This is an updated version which recognises that, not only should all echocardiographers be individually accredited as competent to practice, but that departments also need to be well organised and have the facilities, equipment and processes to ensure the services they deliver are of an appropriate clinical standard. In combination with individual accreditation, departmental accreditation lays down standards to help ensure safe and effective patient care. These standards supersede the 2012 BSE Departmental Accreditation Standards. Standards are set to cover all potential areas of practice, including transthoracic (level 2) echocardiography, transoesophageal echocardiography, stress echocardiography, training, and emergency (level 1) echocardiography. The emergency echocardiography standard is a new addition to departmental accreditation and has been developed with input from the Intensive Care Society.