title: Recurrent cerebral abscess secondary to a persistent left superior vena cava.
abstract: Cerebral abscess is a serious neurological condition that is often of unclear etiology. Management is usually medical therapy with or without direct drainage, and when patients have recurrent episodes a structural abnormality should be considered. Persistent left superior vena cava is an uncommon condition in the absence of other forms of congenital heart disease. This venous connection most often enters the right-sided atrium through the coronary sinus but occasionally can connect directly to the left atrium near the wall between the orifice of the left pulmonary veins and left atrial appendage. This later congenital connection results in systemic venous return entering the left atrium directly. Thus allowing unfiltered, lower saturation blood entering the systemic system. This then places the patient at risk for systemic hypoxemia, paradoxical embolic events, and cerebral abscess. In our case report with recurrent cerebral abscess and a persistent left superior vena cava, we demonstrate when to consider this diagnosis, how to make the diagnosis, and a nonsurgical approach to repair the veno-atrial shunt.
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, USA.
authors.forename: Jonathan N
authors.initials: JN
authors.lastname: Menachem
authors.forename: Senthil N
authors.initials: SN
authors.lastname: Sundaram
authors.forename: John F
authors.initials: JF
authors.lastname: Rhodes
mesh_terms: D061605:Administration, Intravenous; D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001922:Brain Abscess / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D002405:Catheterization, Central Venous; D017548:Echocardiography, Transesophageal; D004621:Embolization, Therapeutic / Q000295:instrumentation; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D010690:Phlebography / Q000379:methods; D011237:Predictive Value of Tests; D012008:Recurrence; D013290:Streptococcal Infections / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D054079:Vascular Malformations / Q000150:complications* / Q000175:diagnosis / Q000628:therapy; D014683:Vena Cava, Superior / Q000002:abnormalities* / Q000000981:diagnostic imaging; D034363:Viridans Streptococci / Q000302:isolation & purification*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Catheter-Based Interventions; Cerebral Abscess; Congenital Heart Disease; Persistent Veno-Atrial Shunt