Paralytic ileus precipitating platypnoea–orthodeoxia after right pneumonectomy

A 78-year-old female underwent a right pneumonectomy for a neuroendocrine tumour. In the early postoperative phase, she developed a paralytic ileus and went on to develop breathlessness and orthostatic desaturation, which characterizes platypnoea–orthodeoxia. She was found to have an intra-atrial shunt on bubble echo, with equal atrial pressures. This was managed by device closure of the atrial connection, following which her condition improved.