Endovascular management of pulmonary arteriovenous malformations presenting as multiple brain abscesses

Abstract

Pulmonary arteriovenous malformations (PAVMs) are rare vascular lesions characterised by abnormal connections between the pulmonary artery and vein bypassing the pulmonary capillary bed and causing right-to-left shunt. Paradoxical embolism is known to occur in these cases, leading to inoculation of septic focus in the systemic circulation. We report a case of multiple PAVMs who presented clinically with seizures and altered sensorium. On radiological work-up, multiple brain abscesses and large PAVMs were evident. The patient was successfully treated by endovascular embolisation of the PAVMs using a vascular plug and multiple coils. The patient showed complete clinical recovery and resolution of brain abscesses on follow-up.

Intracranial and Intraventricular Abscess – Neurosurgical Management

“…Infective endocarditis, commonly caused by S. aureus or oral Streptococci, can present as cryptogenic abscess without major symptoms or bilateral disease given the dissemination from the heart. Congenital malformations of the cardiopulmonary circulation, such as pulmonary arteriovenous malformations [18] and extracardiac shunts [19], can predispose patients to BA [12]. Otogenic BA arise in the setting of chronic middle ear inflammation [20] and typically affect the temporal lobe (55%) and cerebellum (28%), with Proteus mirabilis isolated in up to 79% of cases [21].…”