2013
DOI: 10.1136/bcr-2012-007810
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Platypnea orthodeoxia: a ‘laid-back’ case of dyspnoea

Abstract: A man with end-stage liver disease who presented with shortness of breath. He exhibited clinical platypnea (worsening shortness of breath on sitting up) and orthodeoxia (oxygen desaturation on sitting up). Follow-up investigations led to the diagnosis of hepatopulmonary syndrome.

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Cited by 9 publications
(7 citation statements)
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“…In addition to thismechanism,hepatopulmonarysyndromeis also associated with diffusearteriovenous fistulaeinthe pulmonary circulation. The deoxygenatedvenous blood shunts directly into the pul-monary veins without being oxygenated in thealveoli.In thesepatients, sittinguprightresultsin shifting of blood to the dilatedpre-capillarybeds of the lung bases, causing increasedhypoxemicdyspnea [22][23][24][25]. This postural dyspnea isobservedin 5% ofcirrhotic patients [25] While the etiology of platypneaorthodeoxia isusu-ally attributed to a R to L shunt [1][2][3][4][5]10], 6 of the23patients referred to us with a clinical diagnosisofplatypneaorthodeoxia did not have a R to L shuntbynoninvasive testing.…”
Section: ± ±mentioning
confidence: 99%
“…In addition to thismechanism,hepatopulmonarysyndromeis also associated with diffusearteriovenous fistulaeinthe pulmonary circulation. The deoxygenatedvenous blood shunts directly into the pul-monary veins without being oxygenated in thealveoli.In thesepatients, sittinguprightresultsin shifting of blood to the dilatedpre-capillarybeds of the lung bases, causing increasedhypoxemicdyspnea [22][23][24][25]. This postural dyspnea isobservedin 5% ofcirrhotic patients [25] While the etiology of platypneaorthodeoxia isusu-ally attributed to a R to L shunt [1][2][3][4][5]10], 6 of the23patients referred to us with a clinical diagnosisofplatypneaorthodeoxia did not have a R to L shuntbynoninvasive testing.…”
Section: ± ±mentioning
confidence: 99%
“…When an intracardiac R-L shunt is suspected, contrast-enhanced transthoracic echocardiography after injection of agitated normal saline in the supine and upright position is very sensitive, and allows definitive establishment of diagnosis in most cases [4,19,20]. In our patient, these exams were not conclusive and even misdirected our study to an intra-pulmonary shunt.…”
Section: Discussionmentioning
confidence: 73%
“…POS is a rare condition with less than 200 cases reported in literature to date [1]. Intra-cardiac shunting, pulmonary arteriovenous malformations, and ventilation/perfusion mismatch in the lungs have all been proposed underlying mechanisms of POS [2].…”
Section: Discussionmentioning
confidence: 99%