Brain Abscess in Uncorrected Tetralogy of Fallot Diagnosed During Preparationfor Computed Cardiac Angiotomography 2329 9517 1000193
Brain Abscess in Uncorrected Tetralogy of Fallot Diagnosed During Preparationfor Computed Cardiac Angiotomography 2329 9517 1000193
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ISSN: 2329-9517
DOI: 10.4172/2329-9517.1000193
Abstract
We describe the case of a 9-year-old boy with uncorrected tetralogy of Fallot who presented with seizures at the
computed tomography room during the preparation for cardiac computed tomography angiography in order to
characterize the cardiac defect. The cardiac computed tomography angiography was suspended, and a brain
computed tomography without contrast was performed followed by brain magnetic resonance imaging. The brain
scan showed a large abscess in the right temporo-parietal region with important midline shift. The management of
the patient was a combination of antibiotic therapy and osteoplastic craniotomy with removal of abscess capsule. At
the discharge the patient looks well and no focal deficits on neurological examination were observed. Now-a-days
he is following up with heart surgeons for correction of the tetralogy of Fallot. The aim of this report is highlight the
importance of recognizing the brain abscess in patients with uncorrected congenital heart disease. The authors also
discuss the better therapeutic option of this serious often fatal complication.
Keywords: Tetralogy of fallot; Brain abscess; Congenital heart revealed a grade IV/VI pansystolic murmur at the left sternal border.
disease; Neurological complications No focal deficit and a Glasgow of 15 points were seen on neurological
examination. The remainder of the physical examination was
Introduction unremarkable. Laboratory data showed hemoglobin - 13.8 g/dl,
hematocrit - 42.4%, leukocytes – 12.8×109/L, neutrophil 71.2%, C-
Cardiovascular disease is a leading cause of mortality in all ages reactive protein - 2.4 mg/dl. Test for plasmodium was negative.
worldwide [1,2]. Tetralogy of Fallot (ToF) is the most common Electrocardiography showed sinus rhythm, right ventricular
cyanotic congenital heart disease (CHD) accounting for 10%. The ToF hypertrophy. Chest X-ray showed a “boot shaped” cardiac silhouette
is characterized by ventricular septal defect, overriding aorta, with an upturned apex and slight concave pulmonary artery segment
hypertrophy of right ventricle and right ventricular outflow tract (Figure 1A). No pulmonary infiltrates were found. Echocardiography
obstruction (RVOT) which can be valvular, infundibular or both [3]. showed a large VSD, nearly 40% overriding of the aorta, right
There have been several reports of neurological complications ventricular hypertrophy with valvular RVOT obstruction (Figure 1B).
associated with ToF [4,5]. Although is known, brain abscess (BA) is a
serious complication in patients with uncorrected CHD mostly in the The patient was prepared to undergo cardiac computed
age of 4-7 years-old [4]. A PubMed search using key words “Tetralogy tomography angiography (CCTA) according to the protocol of our
of Fallot” AND “Brain abscess” yield less than 10 articles in the last 10 cardiothoracic center for all patients with ToF. At the CCTA room the
years. We report this case to highlight the importance of recognizing child started having seizures, and the CCTA was not done. At that
the BA in patients with uncorrected CHD especially in developing moment a brain high resolution computed tomography without
countries where facilities for intervention are often unavailable. We contrast was performed. The brain scan demonstrated an image
also discuss the better therapeutic option of this serious complication. suggestive of large abscess in the right temporo-parietal region with
important midline shift (Figure 1C). There was no evidence of otitis
media, paranasal sinusitis or mastoiditis. The brain magnetic
Case Report resonance imaging (MRI) confirms the diagnosis of brain abscess
A 9-year-old African boy weighing 25 Kg was referred to our (Figure 1D). The patient was evaluated by neurosurgeons and
cardio-thoracic center for correction of ToF, previously diagnosed at underwent osteoplastic craniotomy with removal of abscess capsule.
pediatric hospital David Bernardino. Past history was uneventful. In Culture of the pus was positive for staphylococcus intermedium.
the pediatric hospital the patient presented with fever during the last Triple Antibiotic therapy with vancomycin, ceftriaxone and
five days. On admission at our center, the child presented with right metronidazol was administered intravenously for three weeks. At the
temporo-parietal headache without other complaints. At physical discharge the patient looks well and no focal deficits on neurological
examination cyanosis was present. The pulse was 104 per minute; examination were observed. Now-a-days he is following up with heart
blood pressure of 108/75 mmHg and no fever. Cardiac auscultation, surgeons for correction of the ToF.
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