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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
PubMed
Abstract

Insights

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.
Keywords:
brain abscesscryptogenicpulmonary shunt

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