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When sitting suffocates: a rare cause of platypnoea–orthodeoxia syndrome

Rahul Nema, Chaithra Rajanna, Animesh Ray, Ranveer Singh Jadon, Naval K. Vikram
Breathe 2020 16: 200205; DOI: 10.1183/20734735.0205-2020
Rahul Nema
Dept of Medicine, AIIMS New Delhi, New Delhi, India
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Chaithra Rajanna
Dept of Medicine, AIIMS New Delhi, New Delhi, India
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Animesh Ray
Dept of Medicine, AIIMS New Delhi, New Delhi, India
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  • For correspondence: doctoranimeshray@gmail.com
Ranveer Singh Jadon
Dept of Medicine, AIIMS New Delhi, New Delhi, India
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Naval K. Vikram
Dept of Medicine, AIIMS New Delhi, New Delhi, India
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    Figure 1

    Anteroposterior chest radiograph of the patient at presentation in the emergency department.

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    Figure 2

    High-resolution CT chest sections of the patient at presentation in the emergency department. a) Bilateral lung fields show multiple areas of patchy conslidation and ground-glass opacities (left >right) with volume loss on left side. Few areas of fibroatlectatic and fibrobronchiectatic changes also seen in right middle and lower lobes. b) A section at a lower level than in (a) showing similar changes as described earlier in both lung fields.

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    Figure 3

    West lung zones showing the gravity-dependent blood flow through the lungs.

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    Figure 4

    Flowchart on the workup of platypnoea and orthodeoxia in our patient. V′/Q′: ventilation/perfusion mismatch; 2D ECHO: two-dimensional echocardiography; CTPA: computerised tomography pulmonary angiogram; HRCT: high-resolution CT scan.

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    Figure 5

    Chest radiograph posteroanterior view of the patient before discharge.

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    Figure 6

    Lung ultrasound images of the patient in the a) recumbent and b) sitting position showing an increase in B-profile when sitting.

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    Figure 7

    A flowchart explaining the mechanism of platypnoea–orthodeoxia in our patient. TB: tuberculosis.

Tables

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  • Table 1

    ABG parameters of the patient in the sitting and recumbent position

    ParametersSitting position, room air#Recumbent position, room air¶
    pH7.4777.402
    PaCO223.2 mmHg23.7 mmHg
    PaO250.5 mmHg60.6 mmHg
    SaO283.3%90.2%
    HCO3−17.3 mmol·L−117.1 mmol·L−1
    Alveolar–arterial gradient70.2 mmHg59.5 mmHg

    PaCO2: arterial carbon dioxide tension; SaO2: arterial oxygen saturation; HCO3−: bicarbonate ion concentration; SpO2: oxygen saturation measured by pulse oximeter; FIO2: inspiratory oxygen fraction. #: SpO2 84%, heart rate 113 beats per min, PaO2/FIO2 240; ¶: SpO2 93%, heart rate 79 beats per min, PaO2/FIO2 314.

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    When sitting suffocates: a rare cause of platypnoea–orthodeoxia syndrome
    Rahul Nema, Chaithra Rajanna, Animesh Ray, Ranveer Singh Jadon, Naval K. Vikram
    Breathe Dec 2020, 16 (4) 200205; DOI: 10.1183/20734735.0205-2020

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    When sitting suffocates: a rare cause of platypnoea–orthodeoxia syndrome
    Rahul Nema, Chaithra Rajanna, Animesh Ray, Ranveer Singh Jadon, Naval K. Vikram
    Breathe Dec 2020, 16 (4) 200205; DOI: 10.1183/20734735.0205-2020
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