PMC8168651_01
Magnetic resonance imaging shows typical brain abscess in the left occipital lobe. A T2 (a) hyperintense lesion with hypointense rim surrounded by vasogenic edema. Susceptibility-weighted images show a double rim sign (b), typical for brain abscess. Central diffusion restriction (ADC map - c). T1-weighted images (d and e) after gadolinium show rim enhancement.
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F1
Magnetic resonance imaging (MRI) confirmed this lesion, with central diffusion restriction suggestive for brain abscess [Figure 1].
Coronal (a) and axial (b) chest computed tomography with intravenous contract shows large pulmonary arteriovenous malformation (arrow) in the left lower lobe.
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F2
A contrast-enhanced CT of the chest, to exclude COVID-19 pneumonia, showed a solitary PAVM of the inferior lobe of the left lung [Figure 2].
Control magnetic resonance imaging shows residual abscess in the left occipital lobe after drainage with increased vasogenic edema on T2 (a) and persisted diffusion restriction (ADC map - image b).
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F3
Despite a favorable biochemical evolution, the lesion progressively enlarged on MRI scan [Figure 3].
Digital subtraction angiography. Pulmonary arteriovenous malformation in the left lower lobe (a) (*) and confirmation (b) of complete closure of the feeding vessel after embolization with plug (arrow).
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F4
To prevent recurrence of the abscess, the PAVM was embolized using an endovascular plug [Figure 4].
Follow-up magnetic resonance imaging (5 months postoperatively) shows normal postoperative brain tissue loss and gliosis on T2-weighted image (a) in the left occipital lobe after abscess resection. On T1 (b) after gadolinium, there is no pathologic enhancement. There are no signs of diffusion restriction (ADC map - c).
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F5
After 4 weeks of IV therapy, another 2 weeks of oral antibiotic therapy were prescribed (Clamoxyl 1 g 3/d and metronidazole 500 mg 3/d) Although hemianopsia persisted, subsequent imaging and laboratory testing showed a positive evolution [Figure 5].