title: Intrapulmonary arteriovenous shunt: diagnosis by saline contrast bubbles in the pulmonary veins.
abstract: A 54-year-old man with end-stage cirrhosis of the liver presented for evaluation of dyspnea. Intrapulmonary arteriovenous shunting was suspected. Transthoracic echocardiography with agitated saline contrast injection from the right antecubital vein was performed. Late arrival of saline contrast bubbles in the left atrium by pulmonary veins leading to complete left heart opacification confirmed the diagnosis of significant intrapulmonary shunting. This case and images illustrate the use of agitated saline contrast in combination with transthoracic echocardiography for the diagnosis of intrapulmonary arteriovenous fistula.
authors.affiliation: Cardiology Unit, Department of Medicine, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA.
authors.forename: Anuradha
authors.initials: A
authors.lastname: Gudavalli
authors.forename: Vijay G
authors.initials: VG
authors.lastname: Kalaria
authors.forename: Xucai
authors.initials: X
authors.lastname: Chen
authors.forename: Karl Q
authors.initials: KQ
authors.lastname: Schwarz
mesh_terms: D001164:Arteriovenous Fistula / Q000150:complications / Q000175:diagnosis*; D003326:Coronary Circulation; D003937:Diagnosis, Differential; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography / Q000379:methods*; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000002:abnormalities* / Q000000981:diagnostic imaging; D011667:Pulmonary Veins / Q000002:abnormalities* / Q000000981:diagnostic imaging; D012965:Sodium Chloride
chemical_list: D012965:Sodium Chloride