Hepatic subcapsular CSF pseudocyst

Case contributed by Dr Ahmed Abdrabou


Right hypochondrial swelling after felling down from the bed. The child had mental retardation and obstructive hydrocephalus for which a V-P shunt tube was placed 4 years ago then replaced 1 year ago.

Patient Data

Age: 5 years
Gender: Male

The liver is indented by large amount of subcapsular clear fluid. Also there is free fluid within the peritoneum. High resolution ultrasonography reveals the VP shunt end which lies beneath the hepatic capsule and is surrounded by fluid.

axial non contrast CT with multiplanar reconstruction reveal subcapsular fluid that indents the hepatic parenchyma with a VP shunt tube end seen within it.

While green arrow refers to the diaphragm, the red arrow refers to the hepatic capsule. apparently the tube (curved blue arrow) is seen beneath the capsule. MIP image shows that VP shunt tube curved toward the right hypochondrium.

Case Discussion

This is an unusual complication of VP shunt placement. The abdominal end of the tube dissects the hepatic capsule and enter the hepatic parenchyma. As the tube has many holes for CSF drainage most of CSF drained through the extra hepatic holes while small amount collects within the liver resulted in slowly growing pseudocyst. Due to patient's history of trauma, it was initially interpreted as subcapsular hematoma however the average density of the fluid was lower than hemorrhage (2 HU). Surgical revision of the shunt tube was done.

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