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Standard confirmation often requires echocardiographic microbubble testing or transesophageal echocardiography, which can be impractical in older adults or patients with psychiatric illness due to cooperation needs and cardiology-dependent interpretation. This case report details a 64-year-old woman with persistent hypoxemia in whom lung perfusion scintigraphy demonstrated a right-to-left shunt, while CT excluded intrapulmonary shunting and catheterization confirmed patent foramen ovale.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/platypnea-orthodeoxia-syndrome-associated-with-a-right-to-left-cardiac-shunt-detected-by-lung-perfusion-scintigraphy/457607/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/platypnea-orthodeoxia-syndrome-associated-with-a-right-to-left-cardiac-shunt-detected-by-lung-perfusion-scintigraphy/457607.png","ImageObject",300,407,{"name":92,"@type":93},"Alexandar","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":39},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"What defines platypnea-orthodeoxia syndrome clinically?","Question",{"text":112,"@type":113},"It is characterized by posture-dependent right-to-left shunting that leads to dyspnea in the upright position and improvement when supine.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"Why can echocardiography-based microbubble testing be difficult in some patients?",{"text":117,"@type":113},"It requires patient cooperation (e.g., breath-holding) and typically depends on cardiology involvement, which may be challenging in older adults or psychiatric patients.",{"name":119,"@type":110,"acceptedAnswer":120},"How did lung perfusion scintigraphy contribute to the diagnosis in this case?",{"text":121,"@type":113},"On hospital day 2, lung perfusion scintigraphy demonstrated a right-to-left shunt, supporting the diagnosis when other confirmatory echocardiographic methods were not feasible.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},457607,1790792424,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":39,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":24,"language":139,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":140,"faqs":141,"seo_title":142,"seo_description":67,"update_tm":143,"read_time":144,"preview_page_count":4},962090768658,"https://ap-avatar.wpscdn.com/davatar_6f874abed73319feea01a86fa6f0fab8","e-ISSN 1941-5923  \n© Am J Case Rep, 2025; 26: e949642 DOI: 10. 12659/AJCR.949642  \nReceived: 2025.04.30  \nAccepted: 2025.10.16  \nAvailable online: 2025.11.15  \nPublished: 2025.12.23  \nAuthors’ Contribution: Study Design A  \nData Collection B Statistical Analysis C Data Interpretation D Manuscript Preparation E Literature Search F Funds Collection G  \nABCDEFG 1,2 CDE 1  \nDE 3  \nDE 1  \nDE 1  \nCDE 1  \nCorresponding Author: Financial support: Conflict of interest:  \nPlatypnea-Orthodeoxia Syndrome Associated With a Right-to-Left Cardiac Shunt Detected by Lung Perfusion Scintigraphy  \nYusuke Nakano  Hirohiko Ando Akinori Satake Reiji Goto Kentaro Mukai Tetsuya Amano  \nYusuke Nakano, e-mail: [nakanoy@aichi-med-u.ac.jp](nakanoy@aichi-med-u.ac.jp)  \nNone declared  \nNone declared  \n1 Department of Cardiology, Aichi Medical University, Nagakute, Aichi, Japan  \n2 Department of Internal Medicine, AISAN Clinic, Tsushima, Aichi, Japan  \n3 Department of Cardiology, Narita Memorial Hospital, Toyohashi, Aichi, Japan  \nPatient: Female, 64-year-old  \nFinal Diagnosis: Platypnea orthodeoxia syndrome  \nSymptoms: Hypoxemia  \nClinical Procedure: —  \nSpecialty: Cardiology  \nObjective: Rare disease  \nBackground: Platypnea-orthodeoxia syndrome is a rare condition characterized by posture-dependent right-to-left shunting, resulting in dyspnea in the upright position that improves when supine. Diagnosis usually relies on echocardiographic microbubble testing or transesophageal echocardiography, which require patient cooperation and cardiology support and may be impractical in older or psychiatric patients. Lung perfusion scintigraphy provides a practical, noninvasive alternative for detecting shunts without requiring cooperation or cardiologist involvement. This report describes a case of platypnea-orthodeoxia syndrome associated with a right-to-left cardiac shunt that was detected by lung perfusion scintigraphy.  \nCase Report: A 64-year-old woman with hypertension and severe bipolar disorder was admitted after being found unconscious. She displayed persistent hypoxemia despite oxygen supplementation. Laboratory findings were unremarkable; imaging revealed a dilated aortic root compressing the right atrium but no evidence of pulmonary embolism or pneumonia. Transthoracic echocardiography showed no definitive shunt. Microbubble testing or transesophageal echocardiography could not be performed due to psychiatric instability and lack of immediate cardiology support. On hospital day 2, lung perfusion scintigraphy demonstrated a right-to-left shunt, whereas chest computed tomography excluded intrapulmonary shunting. Cardiac catheterization on day 5 confirmed a patent foramen ovale with right atrial compression, establishing the diagnosis of platypnea-orthodeoxia syndrome. Shunt closure was deferred due to the unavailability of a specialist for percutaneous closure. At 12 months of follow-up, the patient remained untreated.  \nConclusions: Lung perfusion scintigraphy represents a noninvasive and effective diagnostic tool for identifying intracardiac shunting in patients with unexplained hypoxemia when microbubble testing or transesophageal echocardiography is not feasible.  \nKeywords: Bipolar Disorder • Cardiac Imaging Techniques • Radionuclide Imaging •  \nTechnetium Tc 99m Aggregated Albumin  \nFull-text PDF: [https://www.amjcaserep.com/abstract/index/idArt/949642](https://www.amjcaserep.com/abstract/index/idArt/949642)  \n1363  2  2  14  \nPublisher’s note: All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher  \nThis work is licensed under Creative Common AttributionNonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0)  \ne949642-1  \nIndexed in: [PMC] [PubMed] [Emergi","cbCaiaEhdye03WEy","https://ap.wps.com/l/cbCaiaEhdye03WEy","pdf",491319,"English","# Introduction\n# Case Report\n## Diagnostic approach\n# Conclusions","[{\"question\":\"What defines platypnea-orthodeoxia syndrome clinically?\",\"answer\":\"It is characterized by posture-dependent right-to-left shunting that leads to dyspnea in the upright position and improvement when supine.\"},{\"question\":\"Why can echocardiography-based microbubble testing be difficult in some patients?\",\"answer\":\"It requires patient cooperation (e.g., breath-holding) and typically depends on cardiology involvement, which may be challenging in older adults or psychiatric patients.\"},{\"question\":\"How did lung perfusion scintigraphy contribute to the diagnosis in this case?\",\"answer\":\"On hospital day 2, lung perfusion scintigraphy demonstrated a right-to-left shunt, supporting the diagnosis when other confirmatory echocardiographic methods were not feasible.\"}]","Platypnea-Orthodeoxia Syndrome Associated With a Right-to-Left Cardiac Shunt Detected by Lung Perfusion Scintigraphy | PDF",1790749912,13]