Sonographic detection of intrapulmonary shunting of venous gas bubbles during exercise after diving in a professional diver

We report a case of right-to-left intrapulmonary (IP) shunting of venous gas bubbles at a high level of exercise after diving. The diagnosis was made using a 4-chamber view of the heart via echocardiography during exercise. This case is the first in which we could find evidence of IP shunt recruitment during exercise after diving, and the bubble grade was the highest ever seen in our laboratory. Venous bubbles crossing over through IP shunts during exercise after diving is a very rare event.