Detecting intrapulmonary right-to-left shunt with contrast echocardiography. Observations in a patient with diffuse pulmonary arteriovenous fistulas.

Contrast echocardiography has been useful in detecting intracardiac right-to-left shunts. In a patient with hereditary hemorrhagic telangiectasia and diffuse pulmonary arteriovenous fistulas, we have demonstrated the feasibility of detecting intrapulmonary right-to left shunting using this technique. After venous injection of indocyanine green dye, the characteristic contrast flow pattern consisted of a markedly delayed appearance of echoes in the left ventricle.