P143 PLATYPNOEA–ORTHODEOXIA: A CASE REPORT OF A RARE SYNDROME

Abstract A 32–year–old non–smoker Asian female was admitted to the Emergency Department San Salvatore Hospital of L‘Aquila experiencing worsening dyspnea. Three months earlier patient had undergone left pneumonectomy. An arterial blood gas analysis performed on air reported: pH 7.53, pCO2 23.7 mmHg, pO2 38.7 SpO2 80%. Blood tests were within normal limits, except for a moderate increase in D–Dimer. Considering diagnostic hypothesis pulmonary embolism, an Angio CT–scan chest and showed no radiological characteristics suggesting parenchymal pathology evidence thromboembolic or other vascular pathology. From accurate clinical evaluation patient, condition severe platypnoea evident: supine decubitus obliged. Together with above position variations, strong desaturation observed, going from almost values (94–96% SpO2), 80–82% when she sitting up bed. Based data above, right–left shunt assumed, transesophageal contrast echocardiogram requested. The latter demonstrated patency foramen ovale. first description very similar platypnoea–orthodeoxia syndrome following pneumonectomy dates 1956, by Schnabel et al. recent pubmed database–EMBASE systematic review identified 8 studies concerning ten patients, 6 male/4 female. mean age 62 years. All patients underwent resection right lung. time–interval between operation (POS) 2 days 3 PFO present 90%. data, our shows at least two peculiarities; most relevant is young age: fact, there only one POS younger age. second peculiarity localization previous pneumonectomy, much rarer frequency than contralateral known cases. Partial total can rarely be followed onset POS. This severely disabling, so physicians must prepared its prompt recognition, maintaining high degree suspicion.