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[Position dependent dyspnea and cyanosis of the lips at the daily round - A case of Platypnea-Orthodeoxia Syndrome].

HISTORY AND CLINICIAL FINDINGS
 We elaborate a case of a 79-year-old patient who presented with position dependent shortness of breath and cyanosis of the lips at the daily round.


INVESTIGATIONS
 In supine position the patient's oxygen saturation was normal > 95 %, in upright position we noticed a reproducible decrease to 76-85 %. Echocardiographic examination revealed a patent foramen ovale (PFO) with spontaneous right-left shunt and additionally a thoracic aortic aneurysm.


DIAGNOSIS
 Due to a typical position dependent cyanosis, dyspnea and decreased oxygen saturation in combination with patent foramen ovale and aortic aneurysm, Platypnea-Orthodeoxia Syndrome was our suspected diagnosis.


TREATMENT AND COURSE
 After percutaneously occlusion of the foramen ovale the patient presented symptom-free und oxygen saturation remained stable in supine and upright positions. In the follow up examination a significant right-left shunt could no longer be found.


CONCLUSION
 The combination of position dependent shortness of breath and decreased oxygen saturation should lead to the diagnosis of Platypnea-Orthodeoxia Syndrome. The underlying reasons are diverse and not only of cardiologic origin.