Anterior abdominal wall CSF pseudocyst (CSFoma)

Case contributed by Dr Ammar Ashraf

Presentation

Swelling and pain right hypochondrium. History of VP shunt insertion 3 months ago for hydrocephalus.

Patient Data

Age: 40 years
Gender: Female

A right-sided VP shunt is seen in place; its tip is lying in the right hypochondrium within the subcutaneous soft tissues. A well-defined soft tissue density/bulge is seen over the distal end of the VP shunt.

A right-sided VP shunt is seen in place with its tip lying in the subcutaneous soft tissues of the right hypochondrium. A well-defined anechoic fluid collection measuring ~ 6 x 7 cm is noted around the tip of the VP shunt, which is likely a CSF pseudocyst/CSFoma

The coiled distal end of the VP shunt is seen within the subcutaneous soft tissues of the right hypochondrium. A well-defined simple fluid density collection (likely a CSFoma) measuring ~8 x 6 x 6 cm, mildly indenting the underlying anterior abdominal wall muscles, is seen around the tip of the VP shunt. 

Case Discussion

  • Approximately 20 ml of slightly cloudy/pale yellow color fluid was aspirated by the neurosurgeon from right upper quadrant abdominal wall collection and sent for laboratory analysis which showed cerebrospinal fluid with many white blood cells (predominantly polymorphonuclear cells & neutrophils) and elevated protein & glucose levels. No organisms were seen on CSF culture. After aspiration, the VP shunt was replaced by the neurosurgeon.
  • Clinical history, imaging features, and laboratory results are suggestive of VP shunt related infected anterior abdominal wall CSF pseudocyst (CSFoma).
  • Ventriculoperitoneal (VP) shunts are frequently used in the treatment of hydrocephalus. These VP shunts are associated with a few complications including fracture, displacement or blockage of the shunt, infection/peritonitis, bowel perforation, volvulus, pseudo-tumor of the mesentery, and cerebrospinal fluid pseudocyst (CSFoma) 1. CSFoma occurs in 1.0-4.5% cases and is presumed to be caused by shunt related infections, high CSF proteins, or peritoneal adhesions 1.
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Case information

rID: 79453
Published: 28th Jun 2020
Last edited: 24th Dec 2020
Inclusion in quiz mode: Included
Institution: King Abdulaziz Hospital Al Ahsa (MNGHA)

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