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Unusual case of preoperative hypoxaemia

An 82-year-old woman was admitted electively for surgical stabilisation of a persistently painful osteoporotic fracture of T12 vertebra She had a history of kyphosis with two previous osteoporotic fractures at T8 and T9 treated by kyphoplasty. She was noted to be persistently hypoxic with saturations of 80% on room air. She required 4 L/min of oxygen to maintain her saturations at >94%. There was no platypneoa-orthodeoxia. She had no history of significant cardiorespiratory disease, was an ex-20 pack year smoker and denied breathlessness. Cardiorespiratory examination was normal apart from moderate kyphosis.



Figure 1 
Colour flow doppler revealing shunt from right to left atria across a patent foramen ovale (white arrow); Left atrium= LA, Right atrium= RA and interatrial septum= IAS



Chest radiograph was normal as was spirometry with a forced expiratory volume (FEV1) of 132% predicted, forced vital capacity (FVC) of 145% predicted with an FEV …