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Novel partial anomalous pulmonary venous connection associated with brain abscess
Anish Koka1, Amit Sachdev2, Moussa F Yazbeck2
1Department of Cardiology, Thomas Jefferson University, Philadelphia, PA, USA.
Journal of Clinical Neurology (Seoul, Korea)
|January 28, 2014
Summary
Right-to-left shunts can cause brain abscesses. Aggressive evaluation, including bubble studies with left-arm injection, is recommended for cryptogenic brain abscesses to identify these shunts.
Area of Science:
- Neurology
- Cardiology
- Infectious Diseases
Background:
- Right-to-left vascular shunts are a known risk factor for developing brain abscesses.
- Cryptogenic brain abscesses, those with an unknown cause, warrant thorough investigation for underlying conditions.
Purpose of the Study:
- To investigate the association between right-to-left shunts and cryptogenic brain abscesses.
- To highlight the diagnostic utility of specific imaging and bubble studies in identifying these shunts.
Main Methods:
- Case report of a 47-year-old female with a cryptogenic left thalamic abscess.
- Computed tomography (CT) with contrast identified an anomalous pulmonary-to-brachiocephalic vein connection.
- Transthoracic echocardiogram with left-arm bubble injection confirmed a previously undetected right-to-left shunt.
Main Results:
- Streptococcus mitis was identified in the brain abscess upon aspiration.
- An anomalous connection between the left superior pulmonary and brachiocephalic veins was revealed by CT.
- A right-to-left shunt was confirmed via echocardiography using left-arm bubble injection, which was not apparent with right-arm injection.
Conclusions:
- Aggressive evaluation for right-to-left shunts is crucial in patients presenting with cryptogenic brain abscesses.
- Diagnostic recommendations include advanced imaging and bubble studies with left-arm saline injection to detect shunts.
- Early identification of shunts can guide appropriate management and potentially prevent recurrent brain abscesses.
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