{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,23]],"date-time":"2026-08-23T22:12:11Z","timestamp":1787523131087,"version":"build-2736575974"},"reference-count":8,"publisher":"BMJ","issue":"4","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2022,3,17]]},"published-print":{"date-parts":[[2022,4]]},"abstract":"<jats:p>A woman in her 70s was admitted to hospital with worsening shortness of breath and no prior respiratory history of note. This patient\u2019s 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.<\/jats:p>","DOI":"10.1136\/bcr-2021-248502","type":"journal-article","created":{"date-parts":[[2022,4,5]],"date-time":"2022-04-05T11:55:48Z","timestamp":1649159748000},"page":"e248502","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Platypnoea-orthodeoxia syndrome and hemidiaphragm paralysis"],"prefix":"10.1136","volume":"15","author":[{"given":"Abigail","family":"Walker-Jacobs","sequence":"first","affiliation":[{"name":"Norfolk and Norwich University Hospital, Norwich, Norfolk, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Mota","sequence":"additional","affiliation":[{"name":"Norfolk and Norwich University Hospital, Norwich, Norfolk, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karine","family":"Hajjar","sequence":"additional","affiliation":[{"name":"Norfolk and Norwich University Hospital, Norwich, Norfolk, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Omar","family":"Abdul-Samad","sequence":"additional","affiliation":[{"name":"Cardiology Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Prasanna","family":"Sankaran","sequence":"additional","affiliation":[{"name":"Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK"},{"name":"Respiratory Medicine Department, Norfolk and Norwich University Hospital, Norwich, Norfolk, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2022,4,5]]},"reference":[{"key":"2025082801363910000_15.4.e248502.1","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1016\/j.rmed.2017.05.016","article-title":"The multiple dimensions of Platypnea-Orthodeoxia syndrome: a review","volume":"129","author":"Agrawal","year":"2017","journal-title":"Respir Med"},{"key":"2025082801363910000_15.4.e248502.2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1038\/nrdp.2015.86","article-title":"Patent foramen ovale","volume":"2","author":"Homma","year":"2016","journal-title":"Nat Rev Dis Primers"},{"key":"2025082801363910000_15.4.e248502.3","doi-asserted-by":"publisher","DOI":"10.1016\/j.jacc.2005.10.044"},{"key":"2025082801363910000_15.4.e248502.4","doi-asserted-by":"publisher","DOI":"10.3389\/fneur.2020.00001"},{"key":"2025082801363910000_15.4.e248502.5","doi-asserted-by":"crossref","DOI":"10.1183\/13993003.00289-2020","article-title":"Official ERS technical standard: global lung function initiative reference values for static lung volumes in individuals of European ancestry","volume":"57","author":"Hall","year":"2021","journal-title":"Eur Respir J"},{"key":"2025082801363910000_15.4.e248502.6","doi-asserted-by":"crossref","unstructured":"Sakagianni K , Evrenoglou D , Mytas D . Platypnea-orthodeoxia syndrome related to right hemidiaphragmatic elevation and a \u201cstretched\u201d patent foramen ovale. 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