CTICasesPatent Foramen Ovale
Imaging findings
Saline contrast echocardiography shows early right-to-left shunting. Contrast-enhanced chest CT demonstrates a patent foramen ovale (PFO) characterized by a small, oblique slit-like communication along the roof of the interatrial septum, with a jet of highly concentrated contrast material (white smoke) entering the left atrium. An anomalous collateral vein is also seen draining from the superior vena cava directly into the right superior pulmonary vein.
Key takeaways
A patent foramen ovale (PFO) is a common congenital cardiac anomaly resulting from incomplete fusion of the septum primum and septum secundum. While often asymptomatic, PFOs can facilitate paradoxical emboli and right-to-left shunts, especially in patients with elevated right heart pressures. Multidetector CT can directly visualize the flap valve and shunt jet, particularly when heart failure alters relative contrast densities.
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