Platypnoea-Orthodeoxia Syndrome in COVID-19

Salvotti, Francesca; Poiatti, Francesco; Bressa, Stefano; Montani, Giovanni; Nardin, Matteo; Rizzoni, Damiano

doi:10.12890/2021_002849

Cited by 1 publication

(1 citation statement)

References 14 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Ultimately, we found 17 reports on 22 patients with POS associated with COVID-19 (Table 1). Regarding the presence of cardiac shunting, foramen ovale patency was found in three cases [5][6][7] and absent in 13 cases, [8][9][10][11][12][13][14][15][16][17][18] while no echocardiographic results were mentioned in the remaining three reports. [19][20][21] Most cases required respiratory support with high-volume oxygen, noninvasive ventilation, or invasive mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

Platypnea-Orthodeoxia Syndrome in Coronavirus Disease 2019 Pneumonia: A Case Report and Literature Review

Tanimoto¹,

Eriguchi²,

Sato³

et al. 2023

IMCRJ

View full text Add to dashboard Cite

Platypnea-orthodeoxia syndrome (POS) is a rare disorder associated with coronavirus disease 2019 (COVID-19) pneumonia. However, POS may be underdiagnosed. We report the case of a 59-year-old female patient with POS complicated by pulmonary embolism in COVID-19. Imaging revealed ground-glass opacities predominantly in the lower lobes and a pulmonary embolus in the right upper lobe. She was diagnosed with POS due to marked postural discrepancies between supine and upright oxygen saturations and blood oxygenation. Intracardiac shunt, one of the etiologies of POS, was not detected by bubble contrast echocardiography, and postural de-saturation gradually improved with methylprednisolone and edoxaban administration. In our literature review, only 3 of the 16 patients with POS associated with COVID-19 had cardiac shunting, suggesting that moderate to severe COVID-19 causes POS without cardiac shunts. COVID-19-associated vasculopathy and lower lung lesion predominance in COVID-19 pneumonia may cause ventilation-perfusion mismatch due to gravitational shunting of blood into the poorly ventilated lower lungs in the upright position, which may ultimately cause POS. Hypoxemia impedes rehabilitation, whereas early initiation of supine positioning in bed, with knowledge of the pathophysiology of POS, may have a positive effect.

show abstract