Brain abscess as the first manifestation of pulmonary arteriovenous malformation: A case report

Authors

Department of Radiology, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Pulmonary arteriovenous malformations (PAVM) are rare pulmonary vascular anomalies. Although most patients are asymptomatic, right to left shunt produced by PAVM, could result in easy access of septic or non-septic emboli to systemic circulation, end to serious central nervous system (CNS) complication. Here we report a case of brain abscess in a young man. Its source was initially unknown but multiple arteriovenous malformations were detected incidentally in his thoracic CT, which was performed for ruling out embolism. Although the cases of brain abscesses associated with PAVM are very rare, the brain abscess could be an initial clinical manifestation in asymptomatic PAVM as in the case presented in this report.

Keywords

1. Klein JS. Pleura, chest wall, diaphragm and miscellaneous chest disorders. In: Brant WE, Helms CA, editors. Fundamentals of diagnostic radiology. 3 rd ed. USA: Lippincott Williams and Wilkins; 2007. p. 556.   Back to cited text no. 1
    
2. Kinoshita T, Gohara R, Koga T, Sueyasu Y, Terasaki H, Rikimaru T, et al. Visualization of pulmonary arteriovenous malformation by three dimensional computed tomography: A case report. Kurume Med J 2003;50:161-3.  Back to cited text no. 2
[PUBMED]    
3. Lee YS, Kim S, Kang EK, Park JD. A case of hereditary hemorrhagic telangiectasia. Korean J Pediatrics 2007;50:1018-23.  Back to cited text no. 3
    
4. Hirth A, Disney P, Thorne S. Brain abscess associated with an unusual cause of right to left shunt. Heart 2007;93:34.   Back to cited text no. 4
[PUBMED]    
5. Dines DE, Arms RA, Bernatz PE, Gomes MR. Pulmonary arteriovenous fistulas. Mayo Clin Proc 1974;49:460-5.   Back to cited text no. 5
[PUBMED]    
6. Tabakow P, Jarmundowicz W, Czapiga B, Czapiga E. Brain abscess as the first clinical manifestation of multiple pulmonary arteriovenous malformations in a patient with hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease). Folia Neuropathol 2005;43:41-4.   Back to cited text no. 6
    
7. Mathis S, Dupuis-Girod S, Plauchu H, Giroud M, Barroso B, Ly KH, et al. Cerebral abscesses in hereditary haemorrhagic telangiectasia: A clinical and microbiological evaluation. Clin Neurol Neurosurg 2011;114:235-40.   Back to cited text no. 7
[PUBMED]    
8. Hall WA. Hereditary hemorrhagic telangiectasia (Rendu-Osler-Weber disease) presenting with polymicrobial brain abscess. J Neurosurg 1994;81:294-6.   Back to cited text no. 8
[PUBMED]    
9. Wang HC, Yang PC, Kuo SH, Luh KT. Pulmonary arteriovenous malformation: Analysis of 10 cases. J Formos Med Assoc 1998;97:97-100.   Back to cited text no. 9
[PUBMED]    
10. Wong HH, Chan RP, Klatt R, Faughnan ME. Idiopathic pulmonary arteriovenous malformations: Clinical and imaging characteristics. Eur Respir J 2011;38:368-75.   Back to cited text no. 10
[PUBMED]    
11. Momma F, Ohara S, Ohyama T, Moto A, Okada H, Harada H. Brain abscess associated with congenital pulmonary arteriovenous fistula. Surg Neuroln 1990;34:439-41.  Back to cited text no. 11
    
12. Lawler LP, Fishman EK. Multi-detector row CT of thoracic disease with emphasis on 3D volume rendering and CT angiography. Radiographics 2001;21:1257-73.   Back to cited text no. 12
[PUBMED]    
13. Lawler LP, Fishman EK. Arteriovenous malformations and systemic lung supply: Evaluation by multidetector CT and three-dimensional volume rendering. AJR Am J Roentgenol 2002;178:493-5.   Back to cited text no. 13
[PUBMED]    
14. White RI Jr, Pollak JS. Pulmonary arteriovenous malformations: Diagnosis with three-dimensional helical CT-a breakthrough without contrast media. Radiology 1994;191:613-4.   Back to cited text no. 14
[PUBMED]    
15. Khurshid I, Downie GH. Pulmonary arteriovenous malformation. Postgrad Med J 2002;78:191-7.   Back to cited text no. 15
[PUBMED]    
16. Pejhan S, Rahmanjoo N, Farzanegan R, Rahimi M. Surgically treatable pulmonary arterivenous fistula. Ann Thorac Cardiovasc Surg 2012;18:36-8.  Back to cited text no. 16
    
17. Drouet A, Le Moigne F, Donat A, Guilloton L, Felten D. Brain abscess as the first clinical manifestation of isolated pulmonary arteriovenous malformation without Rendu-Osler disease. Rev Neurol 2011;167:29-34.  Back to cited text no. 17
[PUBMED]