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Comprehensive Endovascular and Open Surgical Management of Cerebral Arteriovenous Malformations
Published on: October 20, 2017
Pulmonary arteriovenous malformations in patients with previous brain abscess: a cross-sectional population-based
Jacob Bodilsen1, Trine Madsen2, Christian Thomas Brandt3,4
1Department of Infectious Diseases, Aalborg University Hospital, Aalborg, Denmark.
Background And Purpose:
Pulmonary arteriovenous malformations (PAVMs) may cause recurrent brain abscess. The primary aim was to determine the prevalence of PAVM amongst survivors of brain abscess. The proportion with cardiac right-to-left shunts was also assessed post hoc.
Methods:
This was a cross-sectional population-based study of adult (≥18 years) survivors of cryptogenic bacterial brain abscess in Denmark from 2007 through 2016. Patients were invited for bubble-echocardiography to detect vascular right-to-left shunting and, if abnormal, subsequent computed tomography thorax for diagnosis of PAVM. Data are presented as n/N (%) or median with interquartile range (IQR).
Results:
Study participation was accepted by 47/157 (30%) eligible patients amongst whom two did not appear for scheduled bubble-echocardiography. The median age of participants was 54 years (IQR 45-62) and 19/57 (33%) were females compared with 59 years (IQR 48-68, p = 0.05) and 41/85 females (48%, p = 0.22) in non-participants. Bubble-echocardiography was suggestive of shunt in 10/45 (22%) participants and PAVM was subsequently confirmed by computed tomography in one patient with grade 1 shunting. The corresponding prevalence of PAVM was 2% (95% confidence interval 0.06-11.8) amongst all examined participants. Another 9/45 (20%) were diagnosed with patent in persistent foramen ovale (n = 8) or atrial septum defect (n = 1), which is comparable with the overall prevalence of 25% amongst adults in the Danish background population.
Conclusions:
Undiagnosed PAVM amongst adult survivors of cryptogenic bacterial brain abscess is rare but may be considered in select patients. The prevalence of cardiac right-to-left shunts amongst brain abscess patients corresponds to the prevalence in the general population.
Insights
Pulmonary arteriovenous malformations (PAVMs) are rare in adult brain abscess survivors. This study found a 2% prevalence of PAVM, suggesting it should be considered in select cases.
Area of Science:
- Cardiology
- Neurology
- Radiology
Background:
- Pulmonary arteriovenous malformations (PAVMs) are abnormal connections between pulmonary arteries and veins.
- PAVMs can lead to right-to-left shunting of blood, potentially causing paradoxical embolism and conditions like brain abscess.
- Recurrent brain abscesses in adults may be linked to undiagnosed PAVMs.
Purpose of the Study:
- To determine the prevalence of PAVM in adult survivors of cryptogenic bacterial brain abscess.
- To assess the proportion of these survivors with cardiac right-to-left shunts.
- To evaluate the clinical significance of PAVMs in this patient population.
Main Methods:
- A cross-sectional, population-based study was conducted in Denmark.
- Adult survivors (≥18 years) of cryptogenic bacterial brain abscess from 2007-2016 were invited for bubble-echocardiography.
- Computed tomography (CT) of the thorax was used to confirm PAVM diagnosis in cases with abnormal shunting detected by echocardiography.
Main Results:
- The study included 45 participants who underwent bubble-echocardiography.
- Pulmonary arteriovenous malformations (PAVMs) were confirmed in 1 out of 45 participants, yielding a prevalence of 2%.
- Cardiac right-to-left shunts were detected in 10/45 (22%) participants, with 9 diagnosed with patent foramen ovale or atrial septum defect, comparable to the general population.
Conclusions:
- Undiagnosed PAVMs are rare in adult survivors of cryptogenic bacterial brain abscess.
- PAVM should be considered in the evaluation of select patients with a history of brain abscess.
- The prevalence of cardiac right-to-left shunts in brain abscess survivors is similar to that in the general population.
