Takiguchi Hiroto, Niimi Kyoko, Aoki Takuya, Ogiya Rin, Ohno Yohei, Nakazawa Gaku, Ikari Yuji, Abe Tadashi, Asano Koichiro
Department of Pulmonary Medicine, Tokai University School of Medicine, Japan.
Intern Med. 2013;52(16):1809-11. doi: 10.2169/internalmedicine.52.0578. Epub 2012 Mar 1.
A 79-year-old woman presented with unexplained hypoxia that became exacerbated by an upright posture (platypnea-orthodeoxia syndrome). A (99m)Tc-macroaggregated albumin pulmonary perfusion scan revealed a right to left shunt of 25.5% in the supine position and 32.3% in the sitting position. A dynamic CT scan and a transoesophageal echocardiogram confirmed the presence of a shunt across an atrial septal defect (ASD). A percutaneous transcatheter closure of the defect significantly improved the patient's blood oxygenation levels when she was in the upright position. An ASD should therefore be included in the differential diagnosis of platypnea-orthodeoxia syndrome, regardless of the patient's age.
一名79岁女性出现不明原因的低氧血症，且直立姿势会使其加重（平卧呼吸-直立性低氧血症综合征）。锝-99m标记的大颗粒白蛋白肺灌注扫描显示，仰卧位时右向左分流为25.5%，坐位时为32.3%。动态CT扫描和经食管超声心动图证实存在经房间隔缺损（ASD）的分流。经皮导管封堵缺损显著改善了患者直立位时的血液氧合水平。因此，无论患者年龄如何，ASD均应纳入平卧呼吸-直立性低氧血症综合征的鉴别诊断中。
