Peritoneal CSF pseudocyst

Case contributed by Dr Chris O'Donnell

Presentation

Abdominal discomfort and swelling. VP shunt inserted previously for hydrocephalus. No fever or previous abdominal surgery.

Patient Data

Age: 22
Gender: Female
CT

Very large well-defined fluid collection in the anterior upper abdomen associated with the peritoneal end of a VP shunt.  Almost complete resolution following drainage and replacement of the drainage tube.

CT brain showing 2 shunt tubes in situ, the anterior one not connected to the peritoneum.

Ultrasound

Fluid collection in the abdomen containing internal septations, but otherwise non-echogenic fluid consistent with CSF

Case Discussion

Loculated peritoneal CSF "pseudocysts" - so-called as they have a fibrous wall rather than epithelial are rarely associated with VP shunts.   As they are slowly expanding, they can reach enormous sizes before presentation.  They are thought to be due to low grade infection or peritoneal adhesions.  Many are idiopathic.

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Case information

rID: 39713
Case created: 16th Sep 2015
Last edited: 21st Apr 2017
Inclusion in quiz mode: Included

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