Early appearance of echo-contrast simulating an intracardiac shunt in a patient with liver cirrhosis and intrapulmonary shunting.

Time of appearance of agitated saline contrast in the left atrium is one of the distinguishing features between intracardiac and intrapulmonary shunt. We report a patient with hepatic cirrhosis who had intrapulmonary shunting and had appearance of peripheral venous saline contrast injection in the left heart chambers within 3 cardiac cycles after its appearance in the right heart chambers despite absence of an intracardiac shunt. Thus, time of appearance of saline contrast in the left heart chambers should not be the sole criterion to distinguish intracardiac from intrapulmonary shunt.