Pyogenic Brain Abscess with haemorrhage as the first radiological presentation of hereditary haemorrhagic telangiectasia

Pulmonary arteriovenous malformations (PAVM) are rare pulmonary vascular anomalies that produce right to left shunt, which may result in septic or non-septic emboli to the systemic circulation, leading to serious central nervous system (CNS) complication like cerebral abscess. We report a case of a pyogenic brain abscess in a 72 year old male demonstrating haemorrhage in its walls on CT and GRE sequence of 1.5T MRI as an initial radiological manifestation, and an incidentally detected PAVM on CT scan of the thorax. Further workup revealed multiple telangiectasia in liver and angiodysplasia in stomach suggesting hereditary haemorrhagic telangiectasia.