title: [62-year old male patient with position-depending dyspnoe after hemipneumectomia].
abstract: BACKGROUND
  Dyspnoe is a symptom with a huge differential diagnostic spectrum. According to patients hemodynamic, acute forms can be caused by myocardial infarction, pulmonary embolism, pulmonary edema and heart rhythm disturbances while chronic forms can be caused by restrictive myocardial and pericardial diseases, hematooncological diseases, orthopedic deformations and chronic pulmonary diseases. The platypnea-orthodeoxia syndrome with underlying interatrial connection is a rare cause and need a special diagnostic work-up.
  
  
  METHODS
  A 62-year old male patient with previously known pneumectomy on right side due to underlying cancer presented with a 6-months history of increasing dyspnoe (NYHA III) on exertion and upright position. The physical examination just revealed a lack of ventilation on right side. The saturation drops from 97% in supine position to 68% in upright position. Transesophageal echocardiography revealed a compressed right atrium with a persisted foramen ovale (PFO) and atrial septal aneurysm resulting in a right-left shunt. After completing diagnostic work-up and excluding other possible causes for dyspnoe an interventional closure of interatrial connection was performed. Subsequently the symptoms of the patients resolved (NYHA I).
  
  
  CONCLUSIONS
  The Platypnea-Orthodeoxia-Syndrome isa rare cause of dyspoe. The diagnosis can be made by echocardiography. Medical treatment of such disease is of less success, thus a closure of interatrial connection is recommended.
authors.affiliation: Herzzentrum Duisburg, Akademisches Lehrkrankenhaus, Heinrich-Heine-Universität Düsseldorf, Duisburg, Deutschland.
authors.forename: Elvan
authors.initials: E
authors.lastname: Akin
authors.forename: Ulrich
authors.initials: U
authors.lastname: Krüger
authors.forename: Peter
authors.initials: P
authors.lastname: Braun
authors.forename: Erika
authors.initials: E
authors.lastname: Stroh
authors.forename: Ilse
authors.initials: I
authors.lastname: Janicke
authors.forename: Reza
authors.initials: R
authors.lastname: Rezwanian
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
authors.forename: Wolfgang H
authors.initials: WH
authors.lastname: Schöls
mesh_terms: D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology*; D054092:Foramen Ovale, Patent / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D006322:Heart Aneurysm / Q000150:complications* / Q000175:diagnosis* / Q000628:therapy; D006325:Heart Atria; D006346:Heart Septum; D006801:Humans; D008175:Lung Neoplasms / Q000601:surgery*; D008875:Middle Aged; D011013:Pneumonectomy; D011183:Postoperative Complications / Q000209:etiology*; D055989:Septal Occluder Device