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Boulu X, Karam JD, Dernoncourt A, Duhaut P, Schmidt J. [ Platypnea-orthodeoxia syndrome secondary to pneumonia: Two cases]. Rev Med Interne 2023; 44:143-145. [PMID: 36681524 DOI: 10.1016/j.revmed.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 12/13/2022] [Accepted: 01/08/2023] [Indexed: 01/21/2023]
Abstract
INTRODUCTION The platypnea-orthodeoxia syndrome is a rare situation characterized by the appearance of dyspnea and/or hypoxemia during the transition to orthostatism. OBSERVATIONS We report the case of two patients, who presented with a platypnea-orthodeoxia syndrome following pneumocystis pneumonia and COVID-19, revealing an intracardiac communication with a right-left shunt on contrast ultrasound. CONCLUSION This syndrome can be detected easily at the bedside with positional maneuvers and the shunt demonstrated by a hyperoxia test. Non-reversible situations may require correction of the anatomical anomaly by transcatheter intervention or surgery.
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Affiliation(s)
- X Boulu
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France.
| | - J D Karam
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France
| | - A Dernoncourt
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France
| | - P Duhaut
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France
| | - J Schmidt
- Service de médecine interne et RECIF, centre hospitalier universitaire d'Amiens, 80054 Amiens, France
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Yastrebov K, Sader M, Youssef G. Anatomical Constellations for Upright Hypoxemia. CASE (Phila) 2023; 7:86. [PMID: 36861097 DOI: 10.1016/j.case.2022.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
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Tachibana M, Kanemaru A, Hatano K, Murata T, Ishikawa J, Harada K. Hypoxemia found after hospitalization with right hemiplegia due to cerebral infarction: platypnea-orthodeoxia syndrome in the older people. J Cardiol Cases 2022; 25:72-75. [PMID: 35079301 DOI: 10.1016/j.jccase.2021.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2021] [Revised: 06/14/2021] [Accepted: 06/28/2021] [Indexed: 11/27/2022] Open
Abstract
An 89-year-old woman was admitted to our hospital for subacute onset of right upper and lower limb weakness and was diagnosed with acute cerebral infarction. During rehabilitation, close observation revealed that her oxygen saturation decreased in the sitting position and improved in the recumbent position without any subjective symptoms of dyspnea. Transthoracic and transesophageal echocardiography and cardiac catheterization revealed a large patent foramen ovale with an atrial septal aneurysm with right-to-left shunting through the defect, and she was diagnosed with platypnea-orthodeoxia syndrome. Her right hemiplegia caused the trunk to collapse, so the patient slumped when in sitting position, and the trunk tilted to the right forward, resulting in an increased right-to-left shunt. Her peripheral capillary oxygen saturation improved in the upright sitting position supported by therapists. This case suggests that right hemiplegia may exacerbate the symptoms of platypnea-orthodeoxia syndrome. <Learning objective: Platypnea-orthodoxia syndrome (POS) is a rare disease and often not clearly diagnosed. Previous studies have reported POS due to patent foramen ovale (PFO) after the onset of subclinical cerebral infarction. To our knowledge, this is the first case to suggest that trunk collapse during sitting due to right hemiplegia exacerbated the hypoxemia caused by POS. Moreover, 20-30% of adults may have asymptomatic PFO. POS may be detected by examining changes in oxygen saturation in different postures.>.
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Affiliation(s)
- Masatoshi Tachibana
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Akiko Kanemaru
- Department of Rehabilitation, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Keiko Hatano
- Department of Neurology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Teppei Murata
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Joji Ishikawa
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
| | - Kazumasa Harada
- Department of Cardiology, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan
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Ogasawara M, Ishiyama A, Sugiura A, Segawa K, Nonaka I, Takeshita E, Shimizu-Motohashi Y, Komaki H, Sasaki M. Duchenne muscular dystrophy with platypnea-orthodeoxia from Chilaiditi syndrome. Brain Dev 2018; 40:339-342. [PMID: 29157800 DOI: 10.1016/j.braindev.2017.11.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2017] [Revised: 10/31/2017] [Accepted: 11/02/2017] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Chilaiditi syndrome is a rare pathophysiology in which the colon or other organs are interposed between the diaphragm and liver, and respiratory or digestive symptoms sometimes manifest. Although there have been some cases of Chilaiditi syndrome complicating neuromuscular disorders, none have described resulting respiratory or digestive symptoms. CASE PRESENTATION Our patient was a 20-year-old man with DMD who had been receiving noninvasive positive-pressure ventilation during the night. He experienced respiratory distress when changing from a supine to sitting position. Ventilator adjustment did not relieve the respiratory distress. Abdominal computed tomography revealed marked constipation and interposition of the transverse colon between the diaphragm and liver, indicating Chilaiditi syndrome. The right side of the diaphragm was elevated by the interposed transverse colon when the respiratory distress was present on chest radiograph, but not when symptoms were absent. The patient was diagnosed with platypnea-orthodeoxia attributed to Chilaiditi syndrome. The respiratory distress was improved by the relief of constipation, in addition to the usage of the ventilator throughout the day. CONCLUSION The rare symptoms and pathophysiology of DMD complicated by Chilaiditi syndrome are reported and discussed herein.
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Affiliation(s)
- Masashi Ogasawara
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Akihiko Ishiyama
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan.
| | - Akira Sugiura
- Department of Neurology, National Epilepsy Center, Shizuoka Institute of Epilepsy and Neurological Disorders, Shizuoka, Japan
| | - Kazuhiko Segawa
- Department of Cardiology, National Center Hospital, NCNP, Tokyo, Japan
| | - Ikuya Nonaka
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Eri Takeshita
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Yuko Shimizu-Motohashi
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Hirofumi Komaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
| | - Masayuki Sasaki
- Department of Child Neurology, National Center Hospital, National Center of Neurology and Psychiatry (NCNP), Tokyo, Japan
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Abstract
A patent foramen ovale (PFO) is a common anatomic finding in 20% of the normal population. Significant hypoxemia can occur in circumstances in which hemodynamic or anatomic changes predispose to increased right-to-left intra-atrial shunting. The subsequent hypoxemia produces substantial dyspnea that may affect the patient's quality of life, independent of underlying pulmonary disease. Profound hypoxemia caused by right-to-left shunt across the interatrial septum usually responds to percutaneous PFO closure. An important impediment to successful treatment is the lack of awareness of the potential role of a PFO in this condition.
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Affiliation(s)
- Jonathan M Tobis
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, Factor Building CHS, Room B-976, Los Angeles, CA 90095, USA.
| | - Deepika Narasimha
- Division of Cardiology, Interventional Cardiology, Loma Linda University Health, 11234 Anderson Street, MC 2434, Loma Linda, CA 92354, USA
| | - Islam Abudayyeh
- Division of Cardiology, Interventional Cardiology, Loma Linda University Health, 11234 Anderson Street, MC 2434, Loma Linda, CA 92354, USA
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Toffetti L, Centola M, Massironi L, Pipia C, Di Marco F, Colombo A, Piccaluga E. Uncommon late presentation of platypnea-orthodeoxia syndrome. J Geriatr Cardiol 2015; 12:687-9. [PMID: 26788048 DOI: 10.11909/j.issn.1671-5411.2015.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Deroux A, Chidlovskii E, Bosc C, Pison C, Couturier P. [ Platypnea-orthodeoxia syndrome: a rare cause of severe hypoxemia]. Rev Pneumol Clin 2014; 70:307-310. [PMID: 24661885 DOI: 10.1016/j.pneumo.2014.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2013] [Revised: 01/08/2014] [Accepted: 01/18/2014] [Indexed: 06/03/2023]
Abstract
INTRODUCTION The platypnea-orthodeoxia syndrome (PO) includes: (i) a dyspnea increasing with orthostatism and decreasing in supine position, (ii) wide positional range in arterial oxygen saturation with tachycardia, (iii) and hypoxemia refractory to oxygen therapy. This syndrome is usually related to a cardiac right-left shunt, and rarely to a pulmonary shunt. OBSERVATION We report a case of a patient presenting with a post-lung infection dyspnea associated with severe hypoxemia and shunt effect at blood gas. Contrast-enhanced CT-scan showed no pulmonary embolism. PO syndrome was suspected given the transcutaneous blood oxygen saturation variation from 90% in supine position to 60% in standing position, tachycardia, and absence of response to the intensive oxygen therapy. CONCLUSION This syndrome should be known by physicians as a possible differential diagnose for refractory dyspnea to oxygen since effective treatment is available.
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Affiliation(s)
- A Deroux
- Service de médecine aiguë gériatrique, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France.
| | - E Chidlovskii
- Service de médecine aiguë gériatrique, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - C Bosc
- Service de pneumologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - C Pison
- Service de pneumologie, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
| | - P Couturier
- Clinique universitaire de médecine gériatrique, pôle pluridisciplinaire de médecine, CHU de Grenoble, BP 217, 38043 Grenoble cedex 09, France
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Affiliation(s)
- Tsung O Cheng
- Department of Medicine, The George Washington University, Washington, DC, United States.
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Gourgiotis S, Aloizos S, Gakis C, Salemis NS. Platypnea-orthodeoxia due to fat embolism. Int J Surg Case Rep 2011; 2:147-9. [PMID: 22096710 DOI: 10.1016/j.ijscr.2011.02.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2010] [Revised: 01/26/2011] [Accepted: 02/24/2011] [Indexed: 11/20/2022] Open
Abstract
Platypnea-orthodeoxia is an uncommon syndrome that is characterized by dyspnea relieved by recumbency and deoxygenation following a change from a recumbent to an upright posture. We herein describe a case of platypnea-orthodeoxia in a 75-year-old man after a surgical restoration of a bitrochanteric fracture of his right femur. However, in this extremely rare case, none of the current known anatomical or functional conditions which can cause platypnea-orthodeoxia had been diagnosed. We strongly believe that this syndrome could be also the result of fat embolism.
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Abstract
We report a 54-year-old patient with the association of hepatic dysfunction with cyanosis, severe hypoxemia, platypnea-orthodeoxia, diffuse cutaneous spider nevi, telangiectasia, palmar erythema, digital clubbing and findings of marked intrapulmonary vascular dilation and arterovenous shunt. The diagnosis of hepato-pulmonary-cutaneous syndrome, a term we think more appropriate and inclusive than that of hepato-pulmonary syndrome for this clinicopathological picture, is proposed. The putative underlying mechanism for these connected pulmonary and extrapulmonary syndromic features is discussed.
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Affiliation(s)
- Enrico Capodicasa
- Department of Clinical and Experimental Medicine, University of Perugia, Perugia, Italy
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