PMC6312573_01
Representative computed tomography section at the pulmonary outflow tract level demonstrating non-specific ground glass infiltrate.
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A CT chest was performed and revealed non-specific left predominant bilateral ground glass changes (Fig. 1).
Transoesophageal echo performed in (A) supine and (B) upright position (head of bed at 75 ). In an upright position there is marked increase of right atrial (RA) inflow with shunting of agitated saline contrast into the left atrium (LA).
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The presence of an intracardiac shunt was confirmed on transthoracic (TTE) and transoesophageal echocardiogram (TOE) with intravenous agitated saline contrast, which demonstrated a lipomatously hypertrophied atrial septum with aneurysmal fossa ovalis membrane, a patent foramen ovale (PFO) and right to left shunting that increased significantly on upright positioning (Fig. 2a and b).