Platypnoea-orthodeoxia after left total knee replacement.
Taha Almufti1, Franz Eversheim2, Brett Johnson2
1Medicine, Albury Wodonga Health, Wodonga, Victoria, Australia taha.almufti@gmail.com.
BMJ Case Reports
|October 25, 2019
Summary
Platypnoea-orthodeoxia syndrome (POS) is a rare condition causing breathing difficulty and low oxygen in an upright position. This case showed POS resolved with physiotherapy after knee surgery, without invasive treatment.
Area of Science:
- Cardiology
- Pulmonology
- Geriatric Medicine
Background:
- Platypnoea-orthodeoxia syndrome (POS) is a rare condition causing dyspnea and hypoxemia in an upright posture.
- POS is typically associated with cardiac or pulmonary abnormalities causing a right-to-left shunt.
Observation:
- An 82-year-old woman developed severe hypoxemia and POS following a left total knee replacement.
- Diagnostic evaluation revealed a significant alveolar-arterial oxygen tension difference.
- Hypoxemia was refractory to 100% oxygen administration.
Findings:
- Transesophageal echocardiography confirmed a patent foramen ovale with a right-to-left shunt.
- The patient's POS symptoms improved significantly over six months.
- Resolution was achieved with conservative management, including chest physiotherapy.
Implications:
- This case highlights an unusual presentation of POS post-orthopedic surgery.
- It suggests that conservative management, including physiotherapy, may be effective for POS in select cases.
- POS should be considered in elderly patients with unexplained hypoxemia after surgery, even without a known cardiac history.
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