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European Journal of Echocardiography 2005 6(1):75-78; doi:10.1016/j.euje.2004.06.010
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Copyright © 2005, The European Society of Cardiology

Traditional contrast echocardiography may fail to demonstrate a patent foramen ovale: negative contrast in the right atrium may be a clue

J.E. Lindebooma,*, M.J. van Deudekoma and C.A. Visserb

aDepartment of Cardiology, Rijnstate Hospital, Arnhem, The Netherlands
bDepartment of Cardiology, VU Medical Centre, Amsterdam, The Netherlands

Received 25 May 2004; received in revised form 16 June 2004; accepted after revision 18 June 2004.

* Corresponding author. Department of Cardiology, Rijnstate Hospital, PO box 9555, 6800 Arnhem, The Netherlands. Tel.: +31 26 3515199; fax: +31 26 3515163. j.e.lindeboom{at}12move.nl


  Abstract

We describe a patient who suffered a stroke of unknown origin and presented a patent foramen ovale (PFO) at contrast echocardiography. This PFO was clearly detectable after contrast delivery in the femoral vein, while repeated contrast delivery in an antecubital vein only showed a negative contrast effect, which suggests that the blood crossing the PFO originated from the vena cava inferior.

However, enhanced detection of a PFO by femoral contrast delivery, compared to antecubital injection has been published many years ago, this mode is not widely implemented yet.

With this case report we would like to illustrate that the negative contrast effect may be used as an indicator that a PFO cannot be excluded and a switch to femoral contrast injection is then mandatory.

Keywords: Patent foramen ovale; Contrast echocardiography; Negative contrast; Femoral vein


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