Sonography of extrathoracic left-to-right shunts in infants and children.

Experience with high-resolution, real-time sonography of four infants with differing extrathoracic left-to-right shunts is presented. Intracranial and parahepatic arteriovenous malformations gave rise to congestive heart failure as their primary or sole manifestation. Partial anomalous pulmonary venous return to the inferior vena cava in one patient and to the portal vein in another was associated with other congenital cardiac anomalies. Once an arteriovenous malformation was suspected, sonography was useful as the initial imaging procedure to localize it and to direct attention to the most useful and least hazardous studies for detailed evaluation.