Orthodeoxia and platypnoea after acute organophosphorus poisoning reversed by CPAP: a newly described cause and review of the literature

Bouros, Demosthenes; Agouridakis, Panagiotis; Tsatsakis, Aristidis; Askitopoulou, E.; Nm, Siafakas

doi:10.1016/0954-6111(95)90232-5

Cited by 13 publications

(8 citation statements)

References 27 publications

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“…The etiologic background of this syndrome includes intracardiac shunts, anatomic pulmonary vascular and pulmonary parenchymal shunts, with interatrial communications being the most common etiologic association, but the precise mechanisms are not known [ 5 , 8 , 9 ]. Other diseases associated with platypnea-orthodeoxia include chronic obstructive pulmonary disease (COPD) [ 10 ], constrictive pericarditis [ 11 ], pneumonectomy [ 12 ], paradoxical embolism [ 13 ] and even acute organophosphorus poisoning [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Platypnea and orthodeoxia associated with Pneumocystis jiroveci and Cytomegalovirus pneumonia: a case report

et al. 2009

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IntroductionPlatypnea-orthodeoxia is an uncommon syndrome characterized by dyspnea and deoxygenation accompanying a change to a sitting or standing posture from a recumbent position. It is usually related to interatrial communications, although several other disorders associated with platypnea-orthodeoxia syndrome have been reported. However, the precise mechanisms are unknown.Case presentationWe present the case of a 75-year-old Caucasian woman with chronic renal failure due to vasculitis who was admitted with fever and respiratory failure. She was found to have both Pneumocystis jiroveci and Cytomegalovirus pneumonia. She was HIV negative. Severe platypnea and orthodeoxia were major features of her illness with no history of respiratory, liver or cardiac disease. Further investigation with contrast echocardiography revealed no intracardiac or intrapulmonary shunts. Although one case involving Pneumocystis jiroveci pneumonia and platypnea has been previously reported, to the best of our knowledge, this is the first time that two opportunistic pathogens have been accompanied by platypnea and orthodeoxia. As both lung bases were predominantly affected and no obvious explanation was found, platypnea and orthodeoxia were attributed to significant areas of low or zero ventilation/perfusion (V/Q) ratio.ConclusionPlatypnea-orthodeoxia is a rare and usually underestimated syndrome. Intracardiac shunts and anatomic pulmonary vascular shunts are the most common etiologic associations. However, if a detailed examination reveals no obvious intracardiac or intrapulmonary shunting combined with extensive pulmonary lesions, then severe V/Q mismatching should be considered as the probable explanation.

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Section: Discussionmentioning

confidence: 99%

Platypnea and orthodeoxia associated with Pneumocystis jiroveci and Cytomegalovirus pneumonia: a case report

et al. 2009

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“…However, an underlying cardiac anomaly was noted in the patient. Interestingly, orthodeoxia was alleviated when the patient was given continuous positive airway pressure treatment which could suggest extracardiac shunting related hypoxemia [40]. In addition, Amiodarone lung toxicity has been reported to lead to v/Q mismatch aggravated by standing [41].…”

Section: Miscellaneous Mechanisms Of Posmentioning

confidence: 99%

The multiple dimensions of Platypnea-Orthodeoxia syndrome: A review

Agrawal

Palkar

Talwar

2017

Respiratory Medicine

133

167

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Platypnea-Orthodeoxia syndrome (POS) is a rare clinical entity characterized by dyspnea and arterial desaturation while in the upright position. The various pathophysiologic mechanisms leading to POS has puzzled clinicians for years. The hypoxia in POS has been attributed to the mixing of the deoxygenated venous blood with the oxygenated arterial blood via a shunt. The primary mechanisms of POS in these patients can be broadly classified based on intracardiac abnormalities, extracardiac abnormalities and miscellaneous etiologies. A Patent Foramen Ovale (PFO) was the most common reported site of an intracardiac shunt. In addition to PFO, intracardiac shunt leading to POS has been reported from either an Atrial Septal Defect (ASD) or an Atrial Septal Aneurysm (ASA). Most patients with an intracardiac shunt also demonstrated a secondary anatomic or a functional defect. Extracardiac causes of POS included intra-pulmonary arteriovenous malformations and lung parenchymal diseases. A systematic evaluation is necessary to identify the underlying cause and institute an appropriate intervention. We conducted a review of literature and reviewed 239 cases of POS. In this article, we review the etiology and pathophysiology of POS and also summarize the diagnostic algorithms and treatment modalities available for early diagnosis and prompt treatment of patients presenting with symptoms of platypnea and/or orthodeoxia.

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“…Miscellaneous : Laryngeal carcinoma,45 unilateral paralysis of the diaphragm,46 blunt chest wall trauma,47 new onset ileus,48 radiation-induced bronchial stenosis,49 bronchopleural fistula,50 fat embolism,51 propafenone overdose in Ebstein anomaly,52 osteoporosis and severe kyphosis,53 diabetic autonomic neuropathy,54 progressive autonomic failure55 and acute organophosphorus poisoning 56…”

Section: Discussionmentioning

confidence: 99%

Platypnoea-orthodeoxia syndrome: novel cause for a known condition

Takhar

Biswas²,

Arora

et al. 2014

BMJ Case Reports

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A 50-year-old man presented with dyspnoea while sitting, standing and walking but resolved completely in supine position. On cardiorespiratory examinations, fine crackles were noted over bibasal area. Chest X-ray showed bilateral reticulonodular shadows, restrictive pattern on spirometry, elevated alveolar arterial O2 gradient on arterial blood gas. High-resolution CT of the thorax revealed pattern as 'confident' or 'certain' radiographic diagnosis of idiopathic pulmonary fibrosis (IPF). Bubble-contrast echocardiography in recumbent, sitting and upright positions revealed no intracardiac (right to left shunt) or intrapulmonary shunts. This case highlights the necessity of awareness of this syndrome in cases of interstitial lung diseases (ILDs) also. Although 188 cases have been described thus far of platypnoea-orthodeoxia syndrome (P-OS) of various aetiologies, to the best of our knowledge, it is the first ever case of P-OS in ILD/IPF. Both lung bases were predominantly affected in this patient, platypnoea and orthodeoxia were attributed to areas of low/zero ventilation/perfusion (V/Q) ratio (zone 1 phenomena) as no other obvious explanation was found.

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Orthodeoxia and platypnoea after acute organophosphorus poisoning reversed by CPAP: a newly described cause and review of the literature

Cited by 13 publications

References 27 publications

Platypnea and orthodeoxia associated with Pneumocystis jiroveci and Cytomegalovirus pneumonia: a case report

Platypnea and orthodeoxia associated with Pneumocystis jiroveci and Cytomegalovirus pneumonia: a case report

The multiple dimensions of Platypnea-Orthodeoxia syndrome: A review

Platypnoea-orthodeoxia syndrome: novel cause for a known condition

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