A patient with sickle anemia may have right-to-left shunting which can increase during sickle-related exacerbations.

Patient selection: sickle cell anemia


Analysis: bubble echocardiography


A right-to-left shunt may be associated with:

(1) patent foramen ovale

(2) intrapulmonary


Flow through the shunt may increase during:

(1) acute chest syndrome

(2) vaso-occlusive crisis

(3) pneumonia


The patient may experience transient hypoxia during episodes of increased shunt flow.


Differential diagnosis of hypoxia:

(1) pulmonary embolism

(2) pneumonia

(3) acute chest syndrome

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