Platypnea and orthodeoxia in a patient with pulmonary embolism

Salvetti, Massimo; Zotti, D.; Bazza, A.; Paini, Anna; Bertacchini, Fabio; Chiari, Ermanna; Coletti, Giuseppe; Rosei, Enrico Agabiti; Muiesan, María Lorenza

doi:10.1016/j.ajem.2012.12.004

Cited by 10 publications

(9 citation statements)

References 4 publications

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“…Patients with pulmonary disease usually have improved ventila-tion when they sit up, and therefore, increase theiroxy-gen saturation in the upright position. However, platypneaorthodeoxia has been described in patients who have lung pathology predominantly affectingthelower lobes, resulting in severe bibasilar ventilation-perfusion mismatch [8].…”

Section: Introductionmentioning

confidence: 99%

The effect of patent foramen ovale closure in patients with platypnea‐orthodeoxia syndrome

Mojadidi

Gevorgyan

Noureddin

et al. 2015

Cathet Cardio Intervent

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Section: Introductionmentioning

confidence: 99%

The effect of patent foramen ovale closure in patients with platypnea‐orthodeoxia syndrome

Mojadidi

Gevorgyan

Noureddin

et al. 2015

Cathet Cardio Intervent

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“…First, there was a documented acute pulmonary embolism (PE) involving the right middle and upper lobes. In the few reported cases of PO-S following PE, the presence of an intracardiac shunt was usually demonstrated [ 4 – 6 ]. In patients with PE and PFO, right-to-left shunting is very likely related to the acute increase in pulmonary artery pressure that determines the reversal of the shunt direction or the development of a right-to-left shunt while sitting upright, in the absence of a left-to-right shunt in a supine position.…”

Section: Discussionmentioning

confidence: 99%

Platypnea–orthodeoxia syndrome in a postoperative patient: a case report

et al. 2021

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Background We report a case of platypnea–orthodeoxia syndrome observed in a complex clinical situation associating a bilateral pleural effusion, lobar pulmonary embolism, and a partial anomalous pulmonary venous return. Case presentation A 57-year-old Caucasian woman developed acute dyspnea in the postoperative course of an elective gynecological surgery for advanced stage ovarian cancer. Preoperative evaluation had failed to reveal any respiratory or cardiac problem. After evidence of a low arterial oxygen saturation, blood gas analysis from the central venous line correctly inserted in the right internal jugular vein revealed a higher oxygen saturation than in the arterial compartment. A thoracic computed tomography showed bilateral pleural effusion, lobar pulmonary embolism, and a drainage of a left pulmonary vein into the left innominate vein. This unique combination resulted in an uncommon cause of platypnea–orthodeoxia syndrome. Conclusion Often associated with right-to-left shunting, platypnea–orthodeoxia syndrome may be observed in complex clinical conditions with several factors influencing the ventilation/perfusion ratio. The paradoxical finding of a higher oxygen saturation in a central venous line than in an arterial line should prompt the clinician to look at the possibility of partial anomalous pulmonary venous return. No specific treatment is required in asymptomatic adults, except for an echocardiographic follow-up to detect the onset of pulmonary hypertension.

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“…Pulmonary : Postpneumonectomy,28 amiodarone-induced pulmonary toxicity,29 recurrent pulmonary emboli,5 adult respiratory distress syndrome,30 pulmonary AVM,31 pulmonary hypertension in obstructive sleep apnoea syndrome,32 true vascular lung shunts,2 bronchogenic carcinoma,33 interstitial fibrosis,34 pulmonary embolism,35 chronic obstructive pulmonary disease (COPD),36 37 emphysema, pneumonectomy16 38–39 and cryptogenic fibrosing alveolitis 40…”

Section: Discussionmentioning

confidence: 99%

Platypnoea-orthodeoxia syndrome: novel cause for a known condition

Takhar

Biswas²,

Arora

et al. 2014

BMJ Case Reports

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A 50-year-old man presented with dyspnoea while sitting, standing and walking but resolved completely in supine position. On cardiorespiratory examinations, fine crackles were noted over bibasal area. Chest X-ray showed bilateral reticulonodular shadows, restrictive pattern on spirometry, elevated alveolar arterial O2 gradient on arterial blood gas. High-resolution CT of the thorax revealed pattern as 'confident' or 'certain' radiographic diagnosis of idiopathic pulmonary fibrosis (IPF). Bubble-contrast echocardiography in recumbent, sitting and upright positions revealed no intracardiac (right to left shunt) or intrapulmonary shunts. This case highlights the necessity of awareness of this syndrome in cases of interstitial lung diseases (ILDs) also. Although 188 cases have been described thus far of platypnoea-orthodeoxia syndrome (P-OS) of various aetiologies, to the best of our knowledge, it is the first ever case of P-OS in ILD/IPF. Both lung bases were predominantly affected in this patient, platypnoea and orthodeoxia were attributed to areas of low/zero ventilation/perfusion (V/Q) ratio (zone 1 phenomena) as no other obvious explanation was found.

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Platypnea and orthodeoxia in a patient with pulmonary embolism

Cited by 10 publications

References 4 publications

The effect of patent foramen ovale closure in patients with platypnea‐orthodeoxia syndrome

The effect of patent foramen ovale closure in patients with platypnea‐orthodeoxia syndrome

Platypnea–orthodeoxia syndrome in a postoperative patient: a case report

Platypnoea-orthodeoxia syndrome: novel cause for a known condition

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