• Mougnyan Cox, Manisha Patel, Sandeep Deshmukh, Christopher G Roth, and Adam E Flanders.
• Thomas Jefferson University, Philadelphia, Pennsylvania, USA. Electronic address: mougnyan.cox@gmail.com.
• World Neurosurg. 2017 May 1; 101: 144-148.

ObjectiveBrain 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.MethodsAll 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.ResultsThis 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).ConclusionsContrast-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.Copyright © 2017 Elsevier Inc. All rights reserved.

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