Skip to main content
SpringerLink
Log in

62-jähriger Patient mit lageabhängiger Dyspnoe nach einseitiger Pneumektomie

62-year old male patient with position-depending dyspnoe after hemipneumectomia

  • fallbericht
  • Published:
Wiener Medizinische Wochenschrift Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Das Platypnea-Orthodeoxie-Syndrom mit zugrundeliegendem interatrialem Shunt und rechts-links Shunt ist eine seltene Ursache und bedarf einer differentierten Abklärung.

Fallbeschreibung

Berichtet wird über einen 62-jährigen Patienten mit seit 6 Monaten progredienter Dyspnoe (NYHA III) im Stehen und Belasten bei Beschwerdelinderung im Liegen. Vorbekannt ist eine Pneumektomie rechts im Rahmen eines Karzinoms. Es zeigt sich ein pulsoxymetrisch gemessener Sättigungsabfall von 97 auf 68 % beim Aufrichten. Echokardiographisch konnte ein persistierendes Foramen ovale (PFO) und Vorhofseptumaneurysma mit kontinuierlichen rechts-links Shunt nachgewiesen werden. Nach Ausschluss weiterer Grunderkrankungen erfolgte ein interventioneller Verschluss des PFO, welches zu einer prompten Symptombesserung und Anstieg der Belastbarkeit (NYHA I) führte.

Schlussfolgerung

Bei klinischem Verdacht auf ein Platypnea-Orthodeoxie-Syndrom mit typischer Anamnese sollte eine echokardiographische Untersuchung zum Nachweis eines interatrialen Shunts durchgeführt werden. Diese Form der Erkrankung spricht nur bedingt auf eine medikamentöse Therapie an und ist mittels Verschluss des interatrialem Shunts effektiv behandelbar.

Summary

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 syndrom with underlying interatrial connection is a rare cause and need a special diagnostic work-up.

Case report

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 pysical 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).

Conclusion

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5
Abb. 6

Literatur

  1. Cheng T. Platypnea-orthodeaxia syndrome: etiology, differential diagnosis, and management. Cathet Cardiovasc Interv. 1999;47:64–6.

    Article  CAS  Google Scholar 

  2. Burchell HB, Helmholz HF, Wood EH. Reflex Orthostatic dyspnea associated with pulmonary hypertension. Am J Physiol. 1949;159:563–4.

    Google Scholar 

  3. Rodrigues P, Palma P, Pereira SP. Platypnea-Orthodeoxia Syndrome in review: defining a new disease. Cardiology. 2012;123:15–23.

    Article  PubMed  Google Scholar 

  4. Ptaszek MP, Saldana F, Palacios IF. Platypnea-Orthodeoxia Syndrome in two previously healthy adults. A case-based review. Clin Med Cardiol. 2009;3:37–43.

    PubMed  PubMed Central  Google Scholar 

  5. Hirai N, Fukunaga T, Kawamo H. Platypnea-Orthodeoxia syndrome with atrial septal defect. Circ J. 2003;67:172–5.

    Article  PubMed  Google Scholar 

  6. Bellato V, Brusa S, Balazova J, et al. Platypnea-orthodeoxia syndrome in interatrial right to left shunt postpneumonectomy. Minerva Anestesiol. 2008;74:271–5.

    PubMed  CAS  Google Scholar 

  7. Godart F, Rey C. Platypnea Orthodeoxia syndrome: a probably underestimated syndrome? Chest. 2001;5:1624–5.

    Article  Google Scholar 

  8. Nakahira A, Matsumura Y, Tatsumi H. Platypnea-Orthodeoxia diagnosed by sitting transoesophageal echocardiography. Ann Thorac Surg. 2010;89:1284–6.

    Article  PubMed  Google Scholar 

  9. Chih-Hsin L, Shih-Tsung C. Shortness of breath while sitting up: hepatopulmonary syndrome. CMAJ. 2011;183:80.

    Article  Google Scholar 

  10. Desouza KA, Saraswat S, DeSouza SA. Platypnea-orthodeoxia syndrome: a diagnostic challenge. South Med J. 2009;102:1046–8.

    Article  PubMed  Google Scholar 

  11. Adolph E, Lacy W, Hermoni Y, et al. Reversible orthodeoxia and platypnea due to right-to-left intracardiac shunting related to pericardial effusion. Ann Intern Med. 1992;116:138–9.

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. I. Medizinische Klinik, Medizinische Fakultät Mannheim, Universität Heidelberg, Theodor-Kutzer Ufer 1–3, 68167, Mannheim, Deutschland

    Ibrahim Akin

  2. Herzzentrum Duisburg, Akademisches Lehrkrankenhaus, Heinrich-Heine-Universität Düsseldorf, Duisburg, Deutschland

    Elvan Akin, Ulrich Krüger, Peter Braun, Erika Stroh, Ilse Janicke, Reza Rezwanian & Wolfgang H. Schöls

Authors
  1. Elvan Akin
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ulrich Krüger
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Peter Braun
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Erika Stroh
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ilse Janicke
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Reza Rezwanian
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ibrahim Akin
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wolfgang H. Schöls
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Ibrahim Akin.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Akin, E., Krüger, U., Braun, P. et al. 62-jähriger Patient mit lageabhängiger Dyspnoe nach einseitiger Pneumektomie. Wien Med Wochenschr 164, 372–376 (2014). https://doi.org/10.1007/s10354-014-0303-z

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10354-014-0303-z

Schlüsselwörter

Keywords

Search

Navigation