Michael D. Offin, MD; Jonathan Menachem, MD; Christian Squillante, MD; Bonnie Ky, MD, MSCE; David Vaughn, MD; Joseph Carver, MD
Disclosures: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M15-0862.
Offin M., Menachem J., Squillante C., Ky B., Vaughn D., Carver J.; Association Among Hypoxemia, Patent Foramen Ovale, and Mediastinal Germ Cell Tumor: A Case Report. Ann Intern Med. 2015;163:243-244. doi: 10.7326/L15-5120
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Published: Ann Intern Med. 2015;163(3):243-244.
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).
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