Key result
Intra-femoral injection of agitated saline bubbles during echocardiography revealed a large patent foramen ovale that was previously missed by antecubital injection due to a large Eustachian valve.
Why the study?
Does intra-femoral injection of agitated saline bubbles improve the detection of patent foramen ovale compared to antecubital injection in patients with a large Eustachian valve?
Case Report (n=1)
No
Does intra-femoral injection of agitated saline bubbles improve the detection of patent foramen ovale compared to antecubital injection in patients with a large Eustachian valve?
Intra-femoral injection of agitated saline bubbles may be necessary to accurately diagnose a patent foramen ovale in patients with a large Eustachian valve when antecubital injection is negative.
The case of a diver with a history of decompression sickness (DCS) after recreational scuba diving is presented. Cutis marmorata, a subtype of cutaneous DCS, has been consistently associated with the presence of a persistent (patent) foramen ovale (PFO) as a risk factor. Diagnostic uncertainty arose when transthoracic echocardiography with antecubital injection of agitated saline bubbles (ASBs) did not show any significant shunt, but the presence of a large Eustachian valve was counteracted by intra-femoral injection of ASBs, showing a large PFO with spontaneous shunting. The importance of proper echocardiography techniques prior to resorting to intra-femoral injection of ASBs to counteract the haemodynamic effects of the Eustachian valve is emphasised.
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Azzopardi et al. (2021) conducted a case report in Decompression sickness and patent foramen ovale (n=1). Intra-femoral injection of agitated saline bubbles during echocardiography vs. Antecubital injection of agitated saline bubbles was evaluated on Detection of patent foramen ovale (right-to-left shunt). Intra-femoral injection of agitated saline bubbles during echocardiography revealed a large patent foramen ovale that was previously missed by antecubital injection due to a large Eustachian valve.
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