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If you're in clinical practice, you've probably coming across an agitated saline contrast (ASC) study today in some way, shape or form - unclear etiology of hypoxemia, cryptogenic CVA, RV dilation, etc. In light of our review 👇, a 🧵 1/ onlinejase.com/article/S0894-…
The principle is simple - agitated saline microbubbles should never be seen in left-sided cardiac structures (i.e. LA, LV, aorta) and if they are, shunting is happening at some level. Classic teaching here is that the lungs act as a sieve for the microbubbles. 2/
This is partially true. The average pulmonary capillary diameter is ~7-8um (👇) so anything larger will be "filtered" out. What about smaller microbubbles (and there are certainly smaller microbubbles made during the agitation process)? 3/ 
