Brain Abscess Caused by Pulmonary Arteriovenous Fistulas without Rendu-Osler-Weber Disease

Abstract

A 52-year-old man was admitted with a brain abscess in the left basal ganglia. He had a paradoxical brain embolic mechanism owing to a pulmonary arteriovenous fistula (PAVF) and was diagnosed as having a right-to-left shunt by transesophageal echocardiography (TEE) and transcranial color Doppler (TCD) with saline contrast medium. We determined that the brain abscess was caused by the PAVFs without Rendu-Osler-Weber disease. TEE and TCD with saline contrast medium were very useful for identifying the presence of the right-to-left shunt that caused the brain abscess.

Pulmonary arteriovenous malformation causing sudden death due to spontaneous hemothorax

“…Other serious problems may result from the impaired filter function due to the lack of intervening capillaries in arteriovenous malformations: if blood clots and clumps of bacteria pass into the venous vessels of the lung, there is a high risk of neurological complications such as stroke or brain abscess. These complications are mainly seen in patients with multiple and diffuse AVMs involving several segments or more than one lobe [32][33][34], whereas in our case, only a single and rather small lung segment was affected. For the above-mentioned reasons, screening for lung AVMs is recommended by HHT centers.…”

Brain abscess associated with patent foramen ovale

“…Thirteen patients (68 %) had odontopathy, and most of the pathogenic bacteria were Staphylococci species, Streptococcus species, and other indigenous oral bacterium. Tetralogy of Fallot [12,17] and pulmonary anterior venous fistula (pAVF) [18,20,27] can cause brain abscess; the right-to-left shunt allows the bacterial mass to circumvent restriction by the pulmonary capillary vessels, thus contributing to cerebral embolization of the bacterial mass and formation of the brain abscess. Only bacillemia of the Streptococcus and Staphylococcus species do not cause brain abscess, as these bacteria are 0.5-1.5 μm in diameter [10,36] and easily pass thorough the cerebral capillary vessels, which are 4-7 μm in diameter [6].…”

“…Brain abscess frequently occurs as a result of an otorhinolaryngological infection [12,14,29], or due to congenital disease manifesting with right-to-left shunt, such as Tetralogy of Fallot [12,17] or pulmonary anterior venous fistula (pAVF) [18,20,27]. In some cases, however, the primary source of the brain abscess remains unknown, which is known as cryptogenic brain abscess (CBA).…”

The bronchial circulation—worth a closer look: A review of the relationship between the bronchial vasculature and airway inflammation

“…The importance of this function is shown by the high prevalence of cerebral emboli and abscess in conditions where the pulmonary circulation is bypassed, namely congenital cardiac disease with right to left shunts 38,39 and pulmonary arteriovenous malformations. 40 Without the nutritive functions of the bronchial circulation, pulmonary circulatory occlusion would lead to lung infarction.…”