Platypnea syndrome after left pneumonectomy

Area of Science:

• Cardiology
• Pulmonary Medicine
• Medical Imaging

Background:

• Platypnea and orthostatic cyanosis are rare symptoms.
• Post-pneumonectomy patients may develop complex cardiopulmonary issues.

Observation:

• A 49-year-old man presented with platypnea and orthostatic cyanosis after a left pneumonectomy.
• Contrast two-dimensional echocardiography (2DE) revealed right-to-left shunting at the atrial level.
• The patient's cyanosis worsened with phlebotomy and improved with volume administration.

Findings:

• An undiagnosed atrial septal defect (ASD) was identified as the cause of the shunting.
• Pneumonectomy likely altered ventricular compliance, facilitating right-to-left shunting through the ASD.
• Surgical repair of the ASD completely resolved the patient's symptoms.

Implications:

• This case underscores the importance of considering intracardiac shunts in patients with unexplained cyanosis after thoracic surgery.
• Contrast 2DE is a valuable tool for diagnosing complex causes of shunting.
• Understanding the interplay between pulmonary resection and cardiac physiology is crucial for managing such cases.