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Case Reports
. 2023 Aug 23:45:101912.
doi: 10.1016/j.rmcr.2023.101912. eCollection 2023.

Position dependent dyspnea and hypoxemia

Bart P C Hoppe  1 , Monica J M van Dam  2 , Hans Dik  2
Affiliations
Case Reports

Position dependent dyspnea and hypoxemia

Bart P C Hoppe et al. Respir Med Case Rep. .

Abstract

A 63-year-old man was analyzed for platypnea-orthodeoxia syndrome (POS). A complete obstruction due to bronchial carcinoma was found in the left main bronchus with bronchoscopy. After left sided pneumonectomy POS resolved completely. Historical reports suggest increased shunting through the left lung could occur in the upright position caused by decreased compression of the left pulmonary artery due to the central bronchial carcinoma. Partially absent hypoxic vasoconstriction was confirmed in this case and suggests (without a relevant shunt through a patent foramen ovale) this 'historical' hypothesis could explain the POS due to increased shunting in the upright position in this patient.

Keywords: Left main bronchus carcinoma; Lung carcinoma; Platypnea-orthodeoxia syndrome.

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Conflict of interest statement

There is no conflict of interest.

Figures

Fig. 1
Fig. 1
Chest x -ray in the supine position showing a complete atelectasis of the left lung.
Fig. 2
Fig. 2
Complete obstruction of the left main bronchus due to adenosquamous carcinoma.
Fig. 3
Fig. 3
Lung perfusion scintigraphy revealed the left lung still showing a perfusion contribution of 30% in recumbent position.
Fig. 4
Fig. 4
Contrast-enhanced CT showing a narrow relation between the central tumour and left main pulmonary artery.
See this image and copyright information in PMC

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