title: Contrast-Enhanced Chest Computed Tomography Reveals Treatable Causes of Cerebral Abscesses in Patients without Antecedent Surgery or Trauma.
abstract: OBJECTIVE
  Brain abscesses cause substantial morbidity and mortality even after appropriate therapy, and no underlying cause is found in 25% of cases. We investigated the added utility of contrast-enhanced chest computed tomography (CT) in the diagnostic work-up of patients presenting with cerebral abscesses and no history or prior trauma or cranial surgery.
  
  
  METHODS
  All patients presenting to a single institution with a surgically proven brain abscess were reviewed. Concurrent contrast-enhanced chest CT imaging results were reviewed when available to identify treatable predisposing causes of intracranial suppuration.
  
  
  RESULTS
  This study included 31 patients with biopsy-proven abscesses. Multiple abscesses were present in 8 patients (26%). Contrast-enhanced CT was performed in 15 patients (48%). Of these 15 patients, 2 had pulmonary arteriovenous malformations, 1 had an intrapulmonary shunt, and 3 had empyemas. Definitive therapy for the chest findings was provided to 6 of the 15 patients (40%). In the remaining 9 patients, 3 had pulmonary abscesses, for which diagnostic aspiration was requested. Another patient had an incidental pulmonary embolism, resulting in same-day placement of an inferior vena caval filter (not included in chest analysis, given that the finding was incidental).
  
  
  CONCLUSIONS
  Contrast-enhanced chest CT is useful for identifying treatable causes of cerebral abscesses in patients with a cerebral abscess and no history of surgery or trauma.
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Electronic address: mougnyan.cox@gmail.com.
authors.forename: Mougnyan
authors.initials: M
authors.lastname: Cox
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Manisha
authors.initials: M
authors.lastname: Patel
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Deshmukh
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Christopher G
authors.initials: CG
authors.lastname: Roth
authors.affiliation: Thomas Jefferson University, Philadelphia, Pennsylvania, USA.
authors.forename: Adam E
authors.initials: AE
authors.lastname: Flanders
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001706:Biopsy; D001922:Brain Abscess / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000601:surgery; D003287:Contrast Media / Q000493:pharmacokinetics; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013909:Thorax / Q000000981:diagnostic imaging*; D015898:Tomography Scanners, X-Ray Computed; D055815:Young Adult
chemical_list: D003287:Contrast Media
keywords: AVM; Abscess; Arteriovenous; Brain; CT; Cerebral; Chest; Empyema; Infection; Pulmonary