Atrial septal aneurysm and defect

The transesophageal echocardiogram was performed with contrast. Panel A shows an aneurysm of the atrial septum. Immediately after the injection of agitated saline, contrast (dashed arrow) can be seen in the right atrium (RA; panel B). With complete filling of the RA, a small amount of contrast is seen entering the left atrium (LA) as a result of a right-to-left shunt through an atrial septal defect (panel C). The contrast is then seen diffusely within the LA (panel D).