Pulmonary arteriovenous fistula (PAVF) is a rare clinical disorder characterized anatomically by an abnormal right-to-left shunt (RLS) at the pulmonary vascular level. RLS was detected by right-heart contrast echocardiography (RHCE), and a large number of contrast microbubbles were detected entering the left atrium and ventricle from the left and right pulmonary veins, Intuitively prompt bilateral pulmonary arteriovenous fistula. Computed tomography angiography confirmed the diagnosis. We report a case of a patient with PAVF complicated with pulmonary hypertension, RHCE with high-frequency transthoracic ultrasound showed the typical signs of pulmonary arteriovenous fistula. We used this method for the first time to diagnose pulmonary arteriovenous fistula.