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. 2024 Apr;31(4):e16176.
doi: 10.1111/ene.16176. Epub 2023 Dec 8.

Pulmonary arteriovenous malformations in patients with previous brain abscess: a cross-sectional population-based study

Jacob Bodilsen  1 , Trine Madsen  2 , Christian Thomas Brandt  3   4 , Katrine Müllertz  5 , Lothar Wiese  3 , Semra Turan Demirci  6 , Hannah Elena Suhrs  6 , Lykke Larsen  7 , Sabine Ute Alice Gill  8 , Birgitte Rønde Hansen  9 , Brian Nilsson  10 , Lars Haukali Omland  11 , Emil Fosbøl  12   13 , Anette Drøhse Kjeldsen  14 , Henrik Nielsen  1   15 ; DASGIB Study Group
Affiliations

Pulmonary arteriovenous malformations in patients with previous brain abscess: a cross-sectional population-based study

Jacob Bodilsen et al. Eur J Neurol. 2024 Apr.

Abstract

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.

Keywords: HHT; PAVM; PFO; brain abscess; cerebral abscess; hereditary haemorrhagic telangiectasia; pulmonary arteriovenous malformation; shunt.

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Conflict of interest statement

All authors declare no conflicts of interests.

References

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