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While in the emergency department, she developed acute arterial oxygen desaturation to 80% on 10?L via Hudson mask, improving to 91% on 100% FiO2 via high-flow mask. She, interestingly, had a previous presentation 3 years prior with dyspnoea. Follow-up CXR, CTPA, V/Q scan, Lung function test and Echocardiogram then only revealed mild left ventricular hypertrophy and a 4.7?cm thoracic aorta aneurysm. There has since been a 12-month history of progressive dyspnoea and dizziness with recurrent falls. Admission CXR and CT chest this time revealed no other additional information, apart from confirming the thoracic aorta aneurysm. She was admitted to Intensive Care Unit and continued to exhibit fluctuating arterial oxygenation levels while changing position. She avoided intubation as she developed no respiratory distress during observation. All other biochemistries were also unremarkable. She underwent Fludarabine nmr a repeat Echocardiogram with contrast bubble study confirming the presence of an interatrial septal aneurysm communication which was accentuated in the upright position. Conclusion:?Platypnoea-Orthodeoxia in this case was most likely caused by an anatomical distortion of the fenestrated septal aneurysm during upright posture. One needs to exercise a high degree of suspicion when encountering such patients, as invasive ventilation can be avoided and definitive treatment can now be offered. COTTEE A1, SAGHAIE T1, CORKE P2, PETERS M1 1Department of Thoracic Medicine, Concord Repatriation General Hospital, NSW 2139, 2Department of Anaesthesia and Pain Management, Concord Repatriation General Hospital, NSW 2139 Dabigatran Introduction:?Adequate analgesia in pleural procedures remains a challenge in interventional pulmonology. Methoxyflurane has an established profile in managing severe pain in trauma medicine, and has the advantage of being a patient-controlled analgesia with minimal risks of respiratory depression. Aim:?To assess the efficacy and tolerance of methoxyflurane during pleural procedures. Method:?This was a prospective study of consecutive consenting patients undergoing invasive pleural procedures at Concord Hospital, from February to August 2013. Patients inhaled methoxyflurane prior to standard local anaesthetic infiltration at the procedural site. IV access was available for learn more supplementary opiate analgesia as needed. Patient and operator questionnaires regarding efficacy and tolerance of methoxyflurane were conducted after pleural procedures and the dose of opiate required was recorded. Results:?Eighteen invasive pleural procedures were performed during this time period, with mean age of 74 years (range 43�C94). Pleural procedures included 12 intercostal catheter insertion (14?Fr, Seldinger technique), one pleural aspiration, two tunnelled intercostal catheters, two medical pleuroscopies and one tunnelled intercostal catheter removal.