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

• Published in: European journal of neurology Vol. 31; no. 4; pp. e16176 - n/a
• Main Authors: Bodilsen, Jacob, Madsen, Trine, Brandt, Christian Thomas, Müllertz, Katrine, Wiese, Lothar, Demirci, Semra Turan, Suhrs, Hannah Elena, Larsen, Lykke, Gill, Sabine Ute Alice, Hansen, Birgitte Rønde, Nilsson, Brian, Omland, Lars Haukali, Fosbøl, Emil, Kjeldsen, Anette Drøhse, Nielsen, Henrik
• Format: Journal Article
• Language: English
• Published: England John Wiley & Sons, Inc 01.04.2024
• Subjects: Abscesses; Brain; brain abscess; cerebral abscess; Computed tomography; Confidence intervals; Echocardiography; Females; Heart; hereditary haemorrhagic telangiectasia; HHT; PAVM; PFO; Population studies; pulmonary arteriovenous malformation; shunt; Shunts; Survival; Thorax; Tomography; Denmark; pulmonary arteriovenous malformation; shunt; HHT; PFO; brain abscess; hereditary haemorrhagic telangiectasia; PAVM; cerebral abscess
• ISSN: 1351-5101; 1468-1331; 1468-1331
• DOI: 10.1111/ene.16176

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.