Management of Tracheomediastinal Fistula Using Self-Expanding Metallic Stents

A paradoxical embolus associated with orthodeoxia-platypnea syndrome and intracardiac shunting is extremely uncommon. We present a patient who was found to have a positional change in desaturation after a right pneumonectomy who suffered from gangrene of the right foot and simultaneous deep venous thrombosis of the left arm. Workup revealed a patent foramen ovale as a cause for both the right-to-left shunt and the paradoxical emboli. After percutaneous closure the orthodeoxia resolved. This case highlights the necessity of heightened awareness of this syndrome in case of severe hypoxemia after pneumonectomy and the importance of an occult patent foramen ovale.