title: An interesting case of positional hypoxia: the effect of multiple synergistic pathological conditions.
abstract: This report describes an elderly patient evaluated for generalized fatigue, dyspnea, presyncopal episodes, and positional hypoxemia. Workup revealed posturally related oxygen desaturation, a patent foramen ovale (PFO), an atrial septal aneurysm, and primary adrenal insufficiency. Normal intracardiac pressures and a right-to-left PFO shunt were present only while the patient was in the upright position. Numerous etiologies of positional right-to-left shunting associated with platypnea-orthodeoxia have been described. Despite advancements in diagnostic and treatment modalities, the pathophysiology of right-to-left shunting with normal intracardiac pressure remains elusive. This report highlights the complexity of positional right-to-left shunting in hypoxemic patients with normal intracardiac pressures and multiple synergistic medical conditions.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Duke University Medical Center, Durham, NC 27713, USA. tempe004@mc.duke.edu
authors.forename: Michael W
authors.initials: MW
authors.lastname: Tempelhof
authors.forename: Alice L
authors.initials: AL
authors.lastname: Gray
authors.forename: Thomas W
authors.initials: TW
authors.lastname: Wallace
mesh_terms: D058186:Acute Kidney Injury / Q000150:complications; D000368:Aged; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology / Q000503:physiopathology; D018618:Echocardiography, Doppler, Color; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000503:physiopathology*; D007738:Kyphosis / Q000150:complications; D011187:Posture / Q000502:physiology*