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Summary: Platypnea-orthodeoxia syndrome is a rare disease characterized by dyspnea and oxygen desaturation induced by the upright position and relieved by recumbency. We report a case of a 65-year-old woman with a recent history of traumatic hip and multiple vertebral fractures referred to our institute due to onset of severe acute dyspnea. Transthoracic and transesophageal echocardiography, conducted by intravenous administration of agitated saline contrast solution, revealed the presence of atrial septal defect (ASD) associated with an important bidirectional shunting that was right-to-left directed when the patient was in a sitting position. Surgical closure of ASD resulted in resolution of the syndrome. [Copyright &y& Elsevier]