Contrast-Enhanced Chest Computed Tomography Reveals Treatable Causes of Cerebral Abscesses in Patients without Antecedent Surgery or Trauma.

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.