Ultrasound For Critical Care Physicians: Where Did the Bubbles Go? 

Monday, August 4, 2014 at 8:00AM
Rick Robbins, M.D. in PFO, bubble study, congenital heart disease, echocariography, heart, pardoxical embolism, patent foramen ovale, right to left shunt, stroke, ultrasound

A 35-year-old woman with factor V Leiden deficiency on chronic anticoagulation therapy and a history of multiple deep vein thrombosis, pulmonary embolism and transient ischemic attacks presented for an evaluation of dyspnea. An echocardiogram with agitated saline contrast (bubble study) was performed (Figure 1).

Figure 1. Apical 4 chamber video taken from bubble study.

What is the best explanation for the findings in the video?

1. Intra-atrial right to left shunting
2. Normal bubble study
3. Pulmonary arterial-venous malformation
4. Ventricular septal defect

Reference as: Natt B, Snyder L, Lax D. Ultrasound for critical care physicians: where did the bubbles go? Southwest J Pulm Crit Care. 2014;9(2):91-3. doi: http://dx.doi.org/10.13175/swjpcc100-14 PDF

Article originally appeared on Southwest Journal of Pulmonary, Critical Care and Sleep (https://www.swjpcc.com/).