• Benjamin A Leaver, Edward R S Cliff, Michael Jefford, Samuel Fogarty, and Dominica Zentner.
• Department of Respiratory Medicine, Royal Melbourne Hospital, Melbourne, Victoria, Australia.
• Intern Med J. 2024 Apr 1; 54 (4): 675677675-677.

AbstractPlatypnoea-orthodeoxia is a rare clinical syndrome characterised by dyspnoea and oxygen desaturation in the upright position which improves when supine. It requires two components: a sufficiently sized anatomical vascular defect (typically intra-cardiac or intra-pulmonary) combined with a functional component that promotes positional right-to-left shunting. We describe the rare occurrence of a patient with platypnoea-orthodeoxia syndrome (POS) because of a paradoxical shunt through a patent foramen ovale caused by a large right atrial line-associated thrombus in a male with metastatic oesophageal cancer undergoing chemotherapy. This case is a timely reminder to consider POS amongst differentials for hypoxia as it is often treatable if recognised.© 2024 Royal Australasian College of Physicians.

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