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December 1974

Orthostatic Hypoxemia in a Patient With Bronchogenic Carcinoma

Author Affiliations

From the Medical Service, Veterans Administration Hospital, and the Department of Medicine, George Washington University Medical Center, and Georgetown University Medical Center, Washington, DC.

Arch Intern Med. 1974;134(6):1113-1115. doi:10.1001/archinte.1974.00320240147021

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