Copyright © Italian Federation of Cardiology. Unauthorized reproduction of this article is prohibited. Uncorrected Ebstein’s anomaly with atrial septal defect complicated by brain abscess in an adult patient Roberto Scarsini a , Maria A. Prioli a , Elena G. Milano a , Valentina Benetti a , Micol Rebonato a , Giovanni Puppini b , Franco Alessandrini c and Corrado Vassanelli a We report the case of a 56-year-old male patient affected by a severe form of Ebstein’s anomaly (type C of Carpentier classi- fication) with secundum atrial septal defect, who presented to the emergency department with impaired consciousness, seizures, and trismus. The brain computed tomography scan showed evidence of a mass located in the frontal lobe, confirmed by brain MRI consistent with brain abscess. Both echocardiography and cardiac MRI showed no evidence of valvular vegetation. This case shows how the combination of increased atrial pressure and bidirectional shunt through atrial septal defect may lead to paradoxical embolization. J Cardiovasc Med 2014, 15:000–000 Keywords: atrial septal defect, brain abscess, congenital heart disease, Ebstein’s anomaly a Section of Cardiology, Department of Medicine, b Section of Radiology and c Section of Neuroradiology, Department of Pathology and Diagnostics, University of Verona, Verona, Italy Correspondence to Roberto Scarsini, MD, Section of Cardiology, Department of Medicine, University of Verona, Verona, Italy Tel: +39 0458122320; fax: +39 0458027307; e-mail: scarsini.roberto@gmail.com Received 19 December 2013 Revised 4 April 2014 Accepted 7 April 2014 A 56-year-old patient presented to the emergency depart- ment unresponsive with eye deviation, seizures, and trismus. Physical examination showed lip cianosis and acrocyanosis, mild finger clubbing, normal heart rate, and a holosystolic murmur. The patient was apyretic. Labora- tory analysis revealed increased hematocrits and mild leukocytosis. ECG showed right atrial dilatation and complete right bundle branch block. Recent medical history included an episode of gingivitis associated with fever and sore throat 2 weeks before; after that, the patient underwent professional teeth cleaning. He had been diagnosed with severe Ebstein’s anomaly (type C of Carpentier classification 1 ) and ostium secun- dum atrial septal defect (ASD) in young age, but he always refused any surgical treatment. In the emergency department, the patient underwent brain computed tomography (CT) scan with evidence of a nodular lesion Images in cardiovascular medicine Fig. 1 Brain MRI showing brain abscess located in the right frontal lobe with perilesional enhancement consistent with edema and tissutal necrosis. (a) axial view; (b) sagital view. 1558-2027 ß 2014 Italian Federation of Cardiology DOI:10.2459/JCM.0000000000000127