Pulmonary Arteriovenous Fistula by Contrast-Transthoracic Echocardiography- A Case Report

Contrast echocardiography with harmonic imaging and contrast injection has improved the accuracy and reproducibility compared to imaging without contrast. Therefore, while evaluation of capillary free communications between pulmonary and systemic circulation is deemed important, assessment after contrast injection should be the preferred approach. We report a case of 60 years old male with alcoholic liver cirrhosis and pulmonary arteriovenous fistula diagnosed by contrast echocardiography. This revealed delayed appearance of contrast 4-5 cardiac cycles with large numbers and the same density of micro-bubbles in all four chambers after 10 cardiac cycles, and when the injection was stopped, there were micro-bubbles in the left cardiac chambers meanwhile none in the right cardiac chambers.