Case Author(s): Hamid Latifi,MD and Jerold Wallis, MD , 8/22/94 . Rating: #D2, #Q3

Diagnosis: Right to left cardiac shunt

Brief history:

Pre lung transplantation workup


Above are posterior, left lateral, LPO, RPO, right lateral and anterior images from a perfusion scan. The anterior image is shown a second time at higher intensity.

View main image(pe) in a separate image viewer

Full history/Diagnosis is available below

Diagnosis: Right to left cardiac shunt

Full history:

5 year old boy with slow growth, who was recently diagnosed with atrial septal defect, patent ductus arteriosus, and resultant pulmonary arterial hypertension. He is now being evaluated for lung transplantation.


Tc-99m MAA, iv


The perfusion images show accumulation of MAA in the kidneys and brain, consistent with right to left shunt.

Differential Diagnosis List

Free pertechnetate can result in renal activity, but this pattern of activity in the brain is specific for a right-to-left shunt.

ACR Codes and Keywords:

References and General Discussion of Ventilation Perfusion Scintigraphy (Anatomic field:Heart and Great Vessels, Category:Normal, Technique, Congenital Anomaly)

Search for similar cases.

Edit this case

Add comments about this case

Return to the Teaching File home page.

Case number: vq003

Copyright by Wash U MO