Brain Abscess in Uncorrected Tetralogy of Fallot Diagnosed during Preparation for Computed Cardiac Angiotomography

Valdano Manuel Ester Matias

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.

Highlights

Cardiovascular disease is a leading cause of mortality in all ages worldwide [1,2]
The Tetralogy of Fallot (ToF) is characterized by ventricular septal defect, overriding aorta, hypertrophy of right ventricle and right ventricular outflow tract obstruction (RVOT) which can be valvular, infundibular or both [3]
A PubMed search using key words “Tetralogy of Fallot” AND “Brain abscess” yield less than 10 articles in the last 10 years. We report this case to highlight the importance of recognizing the brain abscess (BA) in patients with uncorrected congenital heart disease (CHD) especially in developing countries where facilities for intervention are often unavailable

Summary

Introduction

Cardiovascular disease is a leading cause of mortality in all ages worldwide [1,2]. Tetralogy of Fallot (ToF) is the most common cyanotic congenital heart disease (CHD) accounting for 10%. Brain abscess (BA) is a serious complication in patients with uncorrected CHD mostly in the age of 4-7 years-old [4]. A PubMed search using key words “Tetralogy of Fallot” AND “Brain abscess” yield less than 10 articles in the last 10 years We report this case to highlight the importance of recognizing the BA in patients with uncorrected CHD especially in developing countries where facilities for intervention are often unavailable. On admission at our center, the child presented with right temporo-parietal headache without other complaints. Echocardiography showed a large VSD, nearly 40% overriding of the aorta, right ventricular hypertrophy with valvular RVOT obstruction (Figure 1B). The brain scan demonstrated an image suggestive of large abscess in the right temporo-parietal region with important midline shift (Figure 1C). J Cardiovasc Dis Diagn 3: 193. doi:10.4172/2329-9517.1000193

Discussion

Conclusion