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Platypnoea-orthodeoxia syndrome and hemidiaphragm paralysis
  1. Abigail Walker-Jacobs1,
  2. Bruno Mota1,
  3. Karine Hajjar1,
  4. Omar Abdul-Samad2 and
  5. Prasanna Sankaran3,4
  1. 1Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
  2. 2Cardiology Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
  3. 3Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
  4. 4Respiratory Medicine Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK
  1. Correspondence to Dr Abigail Walker-Jacobs; abigail.walker-jacobs{at}


A woman in her 70s was admitted to hospital with worsening shortness of breath and no prior respiratory history of note. This patient’s shortness of breath was posture-dependent; symptoms were markedly worse and oxygen saturations were lower on sitting upright than in recumbency. Her shortness of breath had started several weeks prior to admission and had slowly worsened. Chest X-ray revealed a raised right hemidiaphragm. Further investigation revealed a patent foramen ovale, which was managed with percutaneous closure. This is one of several cases that demonstrate right-to-left shunting through a septal defect secondary to right hemidiaphragmatic paralysis. However, previous reports have not provided a clear guide for management of these cases. We suggest where patients are admitted with new onset breathlessness and platypnoea-orthodeoxia, a septal defect should be suspected. In this report, we have suggested a flowchart for the investigation and management of platypnoea-orthodeoxia syndrome.

  • Respiratory medicine
  • Cardiovascular medicine

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  • Contributors AW-J submits this manuscript along with BM and KH. OA-S and PS supervised the submission of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.