[Severe hypoxemia with orthodeoxia due to right to left shunt in idiopathic bronchiolitis obliterans organizing pneumonia].
We report a case of BOOP with severe hypoxemia and orthodeoxia. Chest X-ray showed bilateral infiltrative pneumonia and computed tomography scan revealed consolidations on lower lobes. Diagnosis of right-to-left shunt was made on the increase of alveolar-arterial oxygen difference under FIO2 100%, accented in standing position. Contrast-enhanced echocardiography and technetium-99 macroaggregated albumin body scanning did not show anatomical right-to-left shunt and permitted the diagnosis of intrapulmonary shunt at the capillary level because of intra-alveolar organisation. Treatment with corticosteroids and cyclophosphamide led to clinical, and radiological improvement with correction of the hypoxemia and the shunt.
Naccache
J M
JM
Service de Pneumologie, Hôpital Cardiovasculaire et Pneumologique Louis Pradel, Lyon.
Faure
O
O
Loire
R
R
Wiesendanger
T
T
Cordier
J F
JF
D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000328:Adult; D018549:Cryptogenic Organizing Pneumonia / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D000860:Hypoxia / Q000209:etiology*; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D011187:Posture; D011652:Pulmonary Circulation; D013902:Radiography, Thoracic; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed
D000305:Adrenal Cortex Hormones; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide