Tilting the balance: hemidiaphragm paralysis leading to right to left cardiac shunt
Patent foramen ovale (PFO) is a congenital abnormality present in 25%–30% of healthy adults and rarely leads to any sequelae. 1 2 It is associated with a left-to-right shunt which usually does not lead to any haemodynamic compromise. Occasionally, the shunt can get reversed; that is, right-to-left s...
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| creator | Ghani, Ali Raza Hamid, Mohsin Dhillon, Puneet Ullah, Waqas |
| description | Patent foramen ovale (PFO) is a congenital abnormality present in 25%–30% of healthy adults and rarely leads to any sequelae. 1 2 It is associated with a left-to-right shunt which usually does not lead to any haemodynamic compromise. Occasionally, the shunt can get reversed; that is, right-to-left shunt occurs due to worsening pulmonary hypertension and can lead to persistent hypoxia. It is rare for the shunt reversal to happen in the absence of pulmonary hypertension. Here, we present an exceedingly rare case in a 61-year-old man presenting with hypoxia, was found to have shunt reversal due to unilateral diaphragmatic paralysis. He was successfully treated with PFO closure. The purpose of this report is to consider rare possibilities of PFO shunt reversal when the right-sided heart pressure is normal and to highlight that a simple chest X-ray can be a clue to the diagnosis. |
| doi_str_mv | 10.1136/bcr-2018-227944 |
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Occasionally, the shunt can get reversed; that is, right-to-left shunt occurs due to worsening pulmonary hypertension and can lead to persistent hypoxia. It is rare for the shunt reversal to happen in the absence of pulmonary hypertension. Here, we present an exceedingly rare case in a 61-year-old man presenting with hypoxia, was found to have shunt reversal due to unilateral diaphragmatic paralysis. He was successfully treated with PFO closure. The purpose of this report is to consider rare possibilities of PFO shunt reversal when the right-sided heart pressure is normal and to highlight that a simple chest X-ray can be a clue to the diagnosis.</description><identifier>ISSN: 1757-790X</identifier><identifier>EISSN: 1757-790X</identifier><identifier>DOI: 10.1136/bcr-2018-227944</identifier><identifier>PMID: 30567185</identifier><language>eng</language><publisher>England: BMJ Publishing Group LTD</publisher><subject>Adult ; Aneurysms ; Antibiotics ; Case reports ; Diagnosis, Differential ; Drug overdose ; Dyspnea ; Echocardiography, Transesophageal ; Embolisms ; Foramen Ovale, Patent - complications ; Foramen Ovale, Patent - diagnosis ; Foramen Ovale, Patent - diagnostic imaging ; Foramen Ovale, Patent - surgery ; Health risk assessment ; Heart ; Humans ; Hypertension, Pulmonary - etiology ; Hypoxia ; Hypoxia - etiology ; Male ; Oxygen therapy ; Pulmonary arteries ; Respiratory Paralysis - complications ; Respiratory Paralysis - diagnosis ; Respiratory Paralysis - diagnostic imaging ; Respiratory Paralysis - surgery ; Unusual Presentation of More Common Disease/Injury ; X-rays</subject><ispartof>BMJ case reports, 2018-12, Vol.11 (1), p.bcr-2018-227944</ispartof><rights>BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>2018 BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ.</rights><rights>BMJ Publishing Group Limited 2018. No commercial re-use. See rights and permissions. Published by BMJ. 2018</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-b3714-91804bb8b4674fb6539f1bf63fa99c4fa9965160fd5bc28c4ae1fbe31e22b8a03</citedby><cites>FETCH-LOGICAL-b3714-91804bb8b4674fb6539f1bf63fa99c4fa9965160fd5bc28c4ae1fbe31e22b8a03</cites><orcidid>0000-0002-7105-4802 ; 0000-0002-4850-0309</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301587/pdf/$$EPDF$$P50$$Gpubmedcentral$$H</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC6301587/$$EHTML$$P50$$Gpubmedcentral$$H</linktohtml><link.rule.ids>230,314,723,776,780,881,27901,27902,53766,53768</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30567185$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ghani, Ali Raza</creatorcontrib><creatorcontrib>Hamid, Mohsin</creatorcontrib><creatorcontrib>Dhillon, Puneet</creatorcontrib><creatorcontrib>Ullah, Waqas</creatorcontrib><title>Tilting the balance: hemidiaphragm paralysis leading to right to left cardiac shunt</title><title>BMJ case reports</title><addtitle>BMJ Case Rep</addtitle><description>Patent foramen ovale (PFO) is a congenital abnormality present in 25%–30% of healthy adults and rarely leads to any sequelae. 1 2 It is associated with a left-to-right shunt which usually does not lead to any haemodynamic compromise. Occasionally, the shunt can get reversed; that is, right-to-left shunt occurs due to worsening pulmonary hypertension and can lead to persistent hypoxia. It is rare for the shunt reversal to happen in the absence of pulmonary hypertension. Here, we present an exceedingly rare case in a 61-year-old man presenting with hypoxia, was found to have shunt reversal due to unilateral diaphragmatic paralysis. He was successfully treated with PFO closure. 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Hamid, Mohsin ; Dhillon, Puneet ; Ullah, Waqas</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-b3714-91804bb8b4674fb6539f1bf63fa99c4fa9965160fd5bc28c4ae1fbe31e22b8a03</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2018</creationdate><topic>Adult</topic><topic>Aneurysms</topic><topic>Antibiotics</topic><topic>Case reports</topic><topic>Diagnosis, Differential</topic><topic>Drug overdose</topic><topic>Dyspnea</topic><topic>Echocardiography, Transesophageal</topic><topic>Embolisms</topic><topic>Foramen Ovale, Patent - complications</topic><topic>Foramen Ovale, Patent - diagnosis</topic><topic>Foramen Ovale, Patent - diagnostic imaging</topic><topic>Foramen Ovale, Patent - surgery</topic><topic>Health risk assessment</topic><topic>Heart</topic><topic>Humans</topic><topic>Hypertension, Pulmonary - etiology</topic><topic>Hypoxia</topic><topic>Hypoxia - etiology</topic><topic>Male</topic><topic>Oxygen therapy</topic><topic>Pulmonary arteries</topic><topic>Respiratory Paralysis - complications</topic><topic>Respiratory Paralysis - diagnosis</topic><topic>Respiratory Paralysis - diagnostic imaging</topic><topic>Respiratory Paralysis - surgery</topic><topic>Unusual Presentation of More Common Disease/Injury</topic><topic>X-rays</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ghani, Ali Raza</creatorcontrib><creatorcontrib>Hamid, Mohsin</creatorcontrib><creatorcontrib>Dhillon, Puneet</creatorcontrib><creatorcontrib>Ullah, Waqas</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing & Allied Health Source</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>BMJ Journals</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>BMJ case reports</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ghani, Ali Raza</au><au>Hamid, Mohsin</au><au>Dhillon, Puneet</au><au>Ullah, Waqas</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Tilting the balance: hemidiaphragm paralysis leading to right to left cardiac shunt</atitle><jtitle>BMJ case reports</jtitle><addtitle>BMJ Case Rep</addtitle><date>2018-12-03</date><risdate>2018</risdate><volume>11</volume><issue>1</issue><spage>bcr-2018-227944</spage><pages>bcr-2018-227944-</pages><issn>1757-790X</issn><eissn>1757-790X</eissn><abstract>Patent foramen ovale (PFO) is a congenital abnormality present in 25%–30% of healthy adults and rarely leads to any sequelae. 1 2 It is associated with a left-to-right shunt which usually does not lead to any haemodynamic compromise. 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| subjects | Adult Aneurysms Antibiotics Case reports Diagnosis, Differential Drug overdose Dyspnea Echocardiography, Transesophageal Embolisms Foramen Ovale, Patent - complications Foramen Ovale, Patent - diagnosis Foramen Ovale, Patent - diagnostic imaging Foramen Ovale, Patent - surgery Health risk assessment Heart Humans Hypertension, Pulmonary - etiology Hypoxia Hypoxia - etiology Male Oxygen therapy Pulmonary arteries Respiratory Paralysis - complications Respiratory Paralysis - diagnosis Respiratory Paralysis - diagnostic imaging Respiratory Paralysis - surgery Unusual Presentation of More Common Disease/Injury X-rays |
| title | Tilting the balance: hemidiaphragm paralysis leading to right to left cardiac shunt |
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