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Abstract

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Article in Japanese

Case Report

A case of pulmonary arteriovenous malformation found in a brain abscess, for which a right-to-left shunt was confirmed with transcranial Doppler sonography

Hiroki Takakura  Nobuyuki Hamanaka  Keisuke Imasaka  Akio Komuro  Teruhiro Aoki  Kunihiko Shimizu 

Division of Respiratory Medicine, Saiseikai Yokohamashi Tobu Hospital

ABSTRACT

The case was a 23-year-old male who presented with headache and fever. Because he was suspected to have a cerebral abscess from a brain CT examination performed by his former physician, the patient was admitted to our hospital. Neck stiffness was recognized and a cerebrospinal test confirmed an increased count of prevailing multinucleated cells. Although blood and cerebral-spinal cultures were found to be negative, we diagnosed his case as a brain abscess with a contrast-enhanced MRI examination. To explore the cause of the disease, we conducted a thorax, contrast-enhanced CT examination and found phymatoid lesions accompanied by inflow and outflow blood vessels at the right S6, which suggested the involvement of pulmonary arteriovenous malformation. Because a right-to-left shunt was found with transcranial Doppler sonography, we diagnosed a cerebral abscess caused by a pulmonary arteriovenous malformation. The cerebral abscess was improved by administering antibiotics, and we performed a segmentectomy of the lower lobe region under video-assisted thoracic surgery. Postoperative transcranial Doppler sonography did not show the right-to-left shunt, and the patient was discharged with no remaining neural-cataplectic symptoms.

KEYWORDS

Pulmonary arteriovenous malformation  Pulmonary arteriovenous fistula  Brain abscess  Right-to-left shunt  Transcranial Doppler sonography 

Received 23 Jul 2012 / Accepted 24 Oct 2012

AJRS, 2(3): 254-258, 2013

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