An interesting case of positional hypoxia: the effect of multiple synergistic pathological conditions.

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Tempelhof, MW; Gray, AL; Wallace, TW

Published Date

  • February 2009

Published In

Volume / Issue

  • 102 / 2

Start / End Page

  • 211 - 213

PubMed ID

  • 19139699

Pubmed Central ID

  • 19139699

Electronic International Standard Serial Number (EISSN)

  • 1541-8243

Digital Object Identifier (DOI)

  • 10.1097/SMJ.0b013e3181889538


  • eng

Conference Location

  • United States