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Case Reports
. 2025 May 1;17(5):e83326.
doi: 10.7759/cureus.83326. eCollection 2025 May.

A Rare Incidental Discovery of an Intrapulmonary Shunt in a Young Man: A Case Report

Varshitha T Panduranga  1 , Mrinal J P Oble  1 , Ammar Y Abdulfattah  1 , Adam S Budzikowski  2 , Samy I McFarlane  1 , Sabu John  3
Affiliations
Case Reports

A Rare Incidental Discovery of an Intrapulmonary Shunt in a Young Man: A Case Report

Varshitha T Panduranga et al. Cureus. .

Abstract

An intrapulmonary shunt (IPS) occurs when blood bypasses oxygenation in the lungs, flowing directly from the right side of the heart to the left side without undergoing gas exchange. This condition is distinct from an intracardiac shunt, which involves an abnormal connection between the heart chambers or vessels, allowing atypical blood flow. In this report, we present the case of a 21-year-old man with a one-year history of persistent cough, nocturnal chest pain, nasal congestion with shortness of breath, and generalized abdominal pain. In the emergency department, his vital signs and physical examination were unremarkable. Electrocardiography (EKG) revealed sinus bradycardia with right-axis deviation and incomplete right bundle branch block pattern. Chest X-ray and routine laboratory investigations were normal. The patient was referred to cardiology for further evaluation of shortness of breath. A transthoracic echocardiogram (TTE) with a bubble study demonstrated a normal ejection fraction of 63% with no regional wall motion abnormalities. Agitated saline injected via the left antecubital vein revealed no bubbles in the left atrium during the first six cardiac cycles. However, after six cycles, a small number of bubbles appeared in the left atrium and left ventricle, indicative of an IPS. In this case report, we highlight a unique incidental finding of an IPS in a young man, emphasizing the importance of bubble study timing in distinguishing IPS from intracardiac shunts.

Keywords: agitated saline contrast studies; echocardiogram with bubble study; intracardiac shunting; intrapulmonary shunt; transthoracic echocardiogram.

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Conflict of interest statement

Human subjects: Consent for treatment and open access publication was obtained or waived by all participants in this study. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. EKG showing sinus bradycardia, right-axis deviation, and incomplete right bundle branch block
Figure 2
Figure 2. Chest X-ray showing no evidence of consolidation or atelectasis indicative of infection
Figure 3
Figure 3. EKG showing persistent sinus bradycardia and incomplete right bundle branch block
Figure 4
Figure 4. Echocardiogram showing no evidence of bubble in the left ventricle (LV) or left atrium (LA) within the six cardiac cycles
Figure 5
Figure 5. Echocardiogram showing bubbles (arrows) visible in the left ventricle (LV) after the six cardiac cycles
See this image and copyright information in PMC

References

    1. Hepatopulmonary syndrome. Kumar P, Rao PN. N Engl J Med. 2020;382:0. - PubMed
    1. Intrapulmonary shunt during normoxic and hypoxic exercise in healthy humans. Lovering AT, Stickland MK, Eldridge MW. Adv Exp Med Biol. 2006;588:31–45. - PubMed
    1. Agitated saline contrast echocardiography in the identification of intra- and extracardiac shunts: connecting the dots. Bernard S, Churchill TW, Namasivayam M, Bertrand PB. J Am Soc Echocardiogr. 2020 - PubMed
    1. Intrapulmonary and intracardiac shunts in adult COVID-19 versus non-COVID acute respiratory distress syndrome ICU patients using echocardiography and contrast bubble studies (COVID-Shunt Study): a prospective, observational cohort study. Lau VI, Mah GD, Wang X, et al. Crit Care Med. 2023;51:1023–1032. - PMC - PubMed
    1. Ultrasound cardiography: contrast studies in anatomy and function. Gramiak R, Shah PM, Kramer DH. Radiology. 1969;92:939–948. - PubMed

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