2], with a clinical presentation of platypnea
(dyspnea induced by upright posture) and orthodeoxia (>5% desaturation or >4mmHg Pa[O.
Patients were further evaluated for presence of platypnea
, cyanosis, clubbing and angiomas; the typical associations of hepatopulmonary syndrome.
One unique patient in our study presented with platypnea
(dyspnea on standing) and orthodeoxia (hypoxemia on standing) because of pulmonary hypertension from tumor emboli in combination with a patent foramen ovale that created a right-to-left intracardiac shunt and the reduced venous return to the heart on standing left an insufficient amount of unshunted blood to keep him from deoxygenation.
and orthodeoxia are not pathognomonic for HPS.
Part II is entitled "Common Presentations in the Outpatient Setting" and includes the following chapters: Chronic Cough, Recurrent Episodes of Purulent Phlegm, Progressive Exertional Dyspnea, Chronic Exertional Dyspnea, Fatigue-Associated Daytime Sleepiness, Solitary Pulmonary Nodule, Hemoptysis, Digital Clubbing, Bilateral Pleural; Effusion, Unilateral Right-Sided Pleural Effusion, Platypnea
, Chronic Hypercapnia, Community-Acquired Pneumonia, Pleuritic Chest Pain, Non-Pleuritic Chest Pain, Upper Lobe Pulmonary Infiltrate, Wheezing, Stridor, Cavitary Pulmonary Infiltrate, and Bilateral Hilar Adenopathy.
5%), cyanosis was present in 2 patients (5%) and platypnea in 6 patients (15%).
Platypnea was present in all patients (100%) of HPS in our study.
This syndrome should be suspected in any patient with underlying liver disease presenting with platypnea
Initial clinical (reference) Symptoms CXR diagnosis 1 (6) Cough, SOA, fever IO APT 2 (6) SOA, fever IO Pneumonitis 3 (6) Cough, SOA, fever IO Pneumonitis 4 (6) Cough, SOA, fever IO Pneumonitis 5 (6) Cough, fever AO ARDS 6 (6) Cough IO CHF 7 (7) Dyspnea, platypnea
IO CHF 8 (8) Hemoptysis, cough, PI Pneumonia SOA, fever 9 (9) Cough, SOA, fever IO, AO Pneumonia 10 Cough, SOA, fever IO, AO Pneumonia, CHF Patient no.
CXR demonstrated a nodular density of the right middle lobe; a subsequent CT scan of the chest revealed several pulmonary AV fistulas in the right middle and lower lobe, likely responsible for her sense of platypnea
with accompanying orthodeoxia.
The first patient had chronic obstructive pulmonary disease, but platypnea did not respond to chronic obstructive pulmonary disease therapy.
Key Words: orthodeoxia, Parkinson disease, platypnea, pulmonary embolism