The transesophageal echocardiogram was performed with contrast. Panel A shows an aneurysm of the atrial septum. Immediately after the injection of agitated saline, contrast (yellow arrow) can be seen in the right atrium (RA) (panel B). With complete filling of the RA, a small amount of contrast is seen entering the left atrium (LA) as a result of a right-to-left shunt through an atrial septal defect (panel C). The contrast is then seen diffusely within the LA (panel D).
Courtesy of Thomas Binder, MD. University of Vienna.
