Association Among Hypoxemia, Patent Foramen Ovale, and Mediastinal Germ Cell Tumor: A Case Report
Authors: Michael D. Offin, Jonathan Menachem, Christian Squillante, Bonnie Ky, David Vaughn, Joseph Carver
Journal: Annals of Internal Medicine (2015)

Letters4 August 2015Association Among Hypoxemia, Patent Foramen Ovale, and Mediastinal Germ Cell Tumor: A Case ReportMichael D. Offin, MD, Jonathan Menachem, MD, Christian Squillante, MD, Bonnie Ky, MD, MSCE, David Vaughn, MD, and Joseph Carver, MDMichael D. Offin, MDFrom Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this author, Jonathan Menachem, MDFrom Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this author, Christian Squillante, MDFrom Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this author, Bonnie Ky, MD, MSCEFrom Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this author, David Vaughn, MDFrom Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this author, and Joseph Carver, MDFrom Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/L15-5120 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Background: A right-to-left shunt (RTLS) is traditionally attributed to increased right-sided cardiac filling pressures in the presence of an intra-atrial communication; however, other unique causes, such as a vector change in blood flow, can also lead to an RTLS.Case Study: A 30-year-old man with no important medical history was treated with antibiotics for a persistent cough. His symptoms did not resolve, and he developed facial plethora and vascular prominence on the chest wall. Radiography and computed tomography of the chest showed a large mediastinal mass abutting the heart and superior vena cava (Figure, panels A, B, and C).Figure.Imaging ...References1. Godart F, Rey C, Prat A, Vincentelli A, Chmaít A, Francart C, et al. Atrial right-to-left shunting causing severe hypoxaemia despite normal right-sided pressures. Report of 11 consecutive cases corrected by percutaneous closure. Eur Heart J. 2000;21:483-9. [PMID: 10681489] CrossrefMedlineGoogle Scholar2. Cox D, Taylor J, Nanda NC. Refractory hypoxemia in right ventricular infarction from right-to-left shunting via a patent foramen ovale: efficacy of contrast transesophageal echocardiography. Am J Med. 1991;91:653-5. [PMID: 1750436] CrossrefMedlineGoogle Scholar3. Dear WE, Chen P, Barasch E, Anderson HV, Varughese AT, Macris MP. Sixty-eight-year-old woman with intermittent hypoxemia. Circulation. 1995;91:2284-9. [PMID: 7697858] CrossrefMedlineGoogle Scholar4. Zanchetta M, Rigatelli G, Ho SY. A mystery featuring right-to-left shunting despite normal intracardiac pressure. Chest. 2005;128:998-1002. [PMID: 16100198] CrossrefMedlineGoogle Scholar5. Murray KD, Kalanges LK, Weiland JE, Binkley PF, Howanitz EP, Galbraith TA, et al. Platypnea-orthodeoxia: an unusual indication for surgical closure of a patent foramen ovale. J Card Surg. 1991;6:62-7. [PMID: 1799735] CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAffiliations: From Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0862. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byImpending paradoxical embolism, patent foramen ovale and pregnancy. Case reportFlow phenomenon, a differential diagnosis in refractory hypoxaemia in patients with anterior mediastinal mass. Case report☆Fenómeno de flujo, diagnóstico diferencial de la hipoxemia refractaria en pacientes con masa mediastinal anterior. Reporte de casoFlow phenomenon, a differential diagnosis in refractory hypoxaemia in patients with anterior mediastinal mass. Case report 4 August 2015Volume 163, Issue 3Page: 243-244KeywordsComputed axial tomographyDisclosureEchocardiographyGerm cellsHypoxiaInferior vena cavaOxygenPulmonary diseasesPulmonary embolismThorax ePublished: 4 August 2015 Issue Published: 4 August 2015 Copyright & PermissionsCopyright © 2015 by American College of Physicians. All Rights Reserved.PDF downloadLoading ...