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Right-to-Left Shunt
Christopher R. McAdams, MD; Hollins Clark, MD
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KEY FACTS

  • Terminology

    • Imaging

      • Diagnostic Checklist

        TERMINOLOGY

        • Definitions

          • Right-to-left shunt: Abnormal shunting of blood through cardiovascular and pulmonary system, bypassing pulmonary capillary circulation
            • Can allow venous to arterial emboli, causing ischemia to multiple organs (e.g., brain, bowel)

        IMAGING

        • Nuclear Medicine Findings

          • Protocol Advice

            DIFFERENTIAL DIAGNOSIS

              DIAGNOSTIC CHECKLIST

              • Image Interpretation Pearls

                Selected References

                1. Society of Nuclear Medicine and Molecular Imaging. SNMMI Procedure Standard for Lung Scintigraphy 4.0. http://snmmi.files.cms-plus.com/docs/Lung_Scintigraphy_V4_Final.pdf. Created July 19, 2011. Accessed July 31, 2015
                2. Ito K et al: Cut-off value for normal versus abnormal right-to-left shunt percentages using (99m)Tc-macroaggregated albumin. Nucl Med Commun. 32(10):936-40, 2011
                3. MacDonald A et al: Infrequently performed studies in nuclear medicine: Part 1. J Nucl Med Technol. 36(3):132-43; quiz 145, 2008
                4. Graves MW et al: Scintigraphic diagnosis of a right to left shunt in end-stage lung disease. Respir Med. 97(5):549-54, 2003
                5. Sugiyama M et al: Scintigraphic evaluation of small pulmonary right-to-left shunt and therapeutic effect in pulmonary arteriovenous malformation. Clin Nucl Med. 26(9):757-60, 2001
                6. Martinez-Jimenez S et al: Nonsurgical extracardiac vascular shunts in the thorax: clinical and imaging characteristics. Radiographics. 30(5):e41, 2010
                7. Roman KS et al: Comparative imaging of differential pulmonary blood flow in patients with congenital heart disease: magnetic resonance imaging versus lung perfusion scintigraphy. Pediatr Radiol. 35(3):295-301, 2005
                8. Eterovic D et al: Gated versus first-pass radioangiography in the evaluation of left-to-right shunts. Clin Nucl Med. 20(6):534-7, 1995
                9. Port SC: Recent advances in first-pass radionuclide angiography. Cardiol Clin. 12(2):359-72, 1994
                10. Madsen MT et al: An improved method for the quantification of left-to-right cardiac shunts. J Nucl Med. 32(9):1808-12, 1991
                Related Anatomy
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                References
                Tables

                Tables

                KEY FACTS

                • Terminology

                  • Imaging

                    • Diagnostic Checklist

                      TERMINOLOGY

                      • Definitions

                        • Right-to-left shunt: Abnormal shunting of blood through cardiovascular and pulmonary system, bypassing pulmonary capillary circulation
                          • Can allow venous to arterial emboli, causing ischemia to multiple organs (e.g., brain, bowel)

                      IMAGING

                      • Nuclear Medicine Findings

                        • Protocol Advice

                          DIFFERENTIAL DIAGNOSIS

                            DIAGNOSTIC CHECKLIST

                            • Image Interpretation Pearls

                              Selected References

                              1. Society of Nuclear Medicine and Molecular Imaging. SNMMI Procedure Standard for Lung Scintigraphy 4.0. http://snmmi.files.cms-plus.com/docs/Lung_Scintigraphy_V4_Final.pdf. Created July 19, 2011. Accessed July 31, 2015
                              2. Ito K et al: Cut-off value for normal versus abnormal right-to-left shunt percentages using (99m)Tc-macroaggregated albumin. Nucl Med Commun. 32(10):936-40, 2011
                              3. MacDonald A et al: Infrequently performed studies in nuclear medicine: Part 1. J Nucl Med Technol. 36(3):132-43; quiz 145, 2008
                              4. Graves MW et al: Scintigraphic diagnosis of a right to left shunt in end-stage lung disease. Respir Med. 97(5):549-54, 2003
                              5. Sugiyama M et al: Scintigraphic evaluation of small pulmonary right-to-left shunt and therapeutic effect in pulmonary arteriovenous malformation. Clin Nucl Med. 26(9):757-60, 2001
                              6. Martinez-Jimenez S et al: Nonsurgical extracardiac vascular shunts in the thorax: clinical and imaging characteristics. Radiographics. 30(5):e41, 2010
                              7. Roman KS et al: Comparative imaging of differential pulmonary blood flow in patients with congenital heart disease: magnetic resonance imaging versus lung perfusion scintigraphy. Pediatr Radiol. 35(3):295-301, 2005
                              8. Eterovic D et al: Gated versus first-pass radioangiography in the evaluation of left-to-right shunts. Clin Nucl Med. 20(6):534-7, 1995
                              9. Port SC: Recent advances in first-pass radionuclide angiography. Cardiol Clin. 12(2):359-72, 1994
                              10. Madsen MT et al: An improved method for the quantification of left-to-right cardiac shunts. J Nucl Med. 32(9):1808-12, 1991