case_images: PMC6312573_01
case_images: Representative computed tomography section at the pulmonary outflow tract level demonstrating non-specific ground glass infiltrate.
case_images: omy049f01.jpg
case_images: PMC6312573_01_omy049f01.jpg
case_images: omy049F1
case_images: A CT chest was performed and revealed non-specific left predominant bilateral ground glass changes (Fig. 1).
case_images: 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).
case_images: omy049f02.jpg
case_images: PMC6312573_01_omy049f02.jpg
case_images: omy049F2
case_images: 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).