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Pulmonary puzzle
Unusual case of preoperative hypoxaemia
  1. Padraic C Ridge,
  2. Sarah Cullivan,
  3. Christina D Campbell,
  4. Anthony O'Regan,
  5. Robert M Rutherford
  1. Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland
  1. Correspondence to Dr Padraic C Ridge, Department of Respiratory Medicine, Galway University Hospitals, Galway, Ireland; p.macaniomaire1{at}

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Clinical presentation

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 …

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  • Contributors PCR gathered the data and drafted the manuscript. RR and AO’R were involved in the clinical management of the patient. All authors were involved in the correction process and redrafts.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement No data are available

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