case_images: PMC10877994_01
case_images: Chest radiography of the first patient revealing a large-volume right pleural effusion upon ICU admission
case_images: cureus-0016-00000052658-i01.jpg
case_images: PMC10877994_01_cureus-0016-00000052658-i01.jpg
case_images: FIG1
case_images: Upon ICU admission, the patient underwent chest radiography revealing a right large-volume pleural effusion (Figure 1).
case_images: Contrast saline transthoracic echocardiography of the first patient in three phases. Sequence 1 revealing micro-bubbles in the right chambers at the moment of saline injection; sequences 2 and 3 revealing micro-bubbles in the left chambers after the sixth and seventh cardiac cycles, respectively
case_images: cureus-0016-00000052658-i02.jpg
case_images: PMC10877994_01_cureus-0016-00000052658-i02.jpg
case_images: FIG2
case_images: In this context, we performed a contrast saline transthoracic echocardiography at the bedside that revealed microbubbles in the cardiac left chambers six beats after peripheral injection, suggesting the presence of intrapulmonary shunt, thereby confirming the diagnosis (Figure 2).
case_images: PMC10877994_02
case_images: Thoracic CT scan revealing a bilateral peripheral linear image suggestive of vascular dilatations (yellow arrows)
case_images: cureus-0016-00000052658-i03.jpg
case_images: PMC10877994_02_cureus-0016-00000052658-i03.jpg
case_images: FIG3
case_images: Then, the patient underwent a high-resolution thoracic CT scan (Figure 3) that revealed bilateral basal non-specific peripheral linear infiltrates, suggesting intra-pulmonary shunts.