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Orthostatic Hypoxemia in a Patient With Bronchogenic Carcinoma

Gerardo Gacad, MD; Nasim Akhtar, MD; Jay N. Cohn, MD
Arch Intern Med. 1974;134(6):1113-1115. doi:10.1001/archinte.1974.00320240147021.
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Dyspnea occurring in recumbency is a common manifestation of left-sided heart failure, but dyspnea limited to the upright position is exceedingly rare. Altman and Robin1 described such a symptom in a patient with emphysema and used the term "platypnea" to denote relief of dyspnea in the recumbent position. The present report describes a patient with bronchogenic carcinoma who developed severe hypoxemia in the sitting or standing position. Marked dyspnea and lightheadedness in the erect position necessitated his remaining supine and led to the false impression of orthostatic hypotension. Ventilatory and hemodynamic studies suggested that the hypoxemia was related to orthostatic shunting of blood through the involved left lung, and complete relief of the syndrome after pneumonectomy confirmed this impression.

Patient Summary  A 48-year-old waiter was admitted to the Washington Veterans Administration Hospital with a three-month history of anorexia and a 15.8-kg (35-lb) weight loss and hemoptysis in the previous


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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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