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Updated: Sep 29, 2026

Assessment of Pulmonary Capillary Blood Volume, Membrane Diffusing Capacity, and Intrapulmonary Arteriovenous Anastomoses During Exercise
Published on: February 20, 2017
Intrapulmonary arteriovenous shunt: diagnosis by saline contrast bubbles in the pulmonary veins
Anuradha Gudavalli1, Vijay G Kalaria, Xucai Chen
1Cardiology Unit, Department of Medicine, University of Rochester, 601 Elmwood Avenue, Rochester, NY 14642, USA.
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.
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